A Case of Round Ligament Varices Presenting in Pregnancy

Abstract

Patient: Female, 34Final Diagnosis: Round ligament varicesSymptoms: Inguinal mass/inflammationMedication: —Clinical Procedure: UltrasoundSpecialty: RadiologyObjective:Challenging differential diagnosisBackground:Round ligament varices (RLV) are rare and are almost exclusively seen in pregnant women. RLV may clinically resemble an inguinal hernia, inguinal mass, or other pathology involving the inguinal canal and round ligament. Ultrasound imaging is important to make the diagnosis of RLV.Case Report:A 34-year-old Hispanic woman, gravida 1 para 0, at 34 weeks gestation, presented to our outpatient department with a complaint of a small, painless, reducible right inguinal mass. Gray-scale sonography showed an asymmetric right inguinal anechoic mass composed of multiple serpentine tubular channels, which became more prominent when the patient performed a Valsalva maneuver. Color Doppler ultrasound imaging showed a hyper vascular structure with a venous flow pattern, consistent with RLV. The patient was treated conservatively and had an uneventful vaginal delivery at 38 weeks gestation. At two weeks postpartum, the RLV spontaneously regressed and her symptoms completely resolved.Conclusions:RLV is a rare condition that should be recognized and diagnosed promptly to prevent patients from undergoing unnecessary surgical exploration. Ultrasound is the diagnostic imaging procedure of choice for the diagnosis of RLV, as well as for patient follow-up and to exclude possible complications associated with RLV.

A Rare but Noteworthy Diagnosis for “Lumps in the Groin” During Pregnancy: Round Ligament Varices

“…It leaves the pelvis via the deep inguinal ring, passes along the inguinal canal, and terminates distally by breaking into several strands inserted into the labium majora. It consists principally of muscular tissue and some fibrous and areolar tissue and contains veins, arteries, lymphatics, and nerves [ 3 , 5 , 7 , 8 ].…”

“…Ultrasound examination can accurately diagnose RLV and exclude an inguinal hernia and other differential diagnoses such as lymphadenopathy, subcutaneous lipoma, soft tissue neoplasms, extra-genital endometriosis, and cystic lymphangiomas [ 1 , 2 , 8 ]. The scan is performed with the patient placed in a supine position and instructed to carry out Valsalva maneuvers.…”

“…After confirming the diagnosis of RLV, reassurance with a “wait-and-see” policy is justified due to the evanescent nature of the entity during pregnancy. Spontaneous resolution of the RLV will occur in most patients postpartum after the pelvic venous engorgement caused by the gravid uterus is relieved [ 2 , 6 , 8 ].…”

Inguinal pain during pregnancy, secondary to round ligament varicosities: case report

“…1 From the clinical point of view, the presence of an inguinal mass that usually associates sensation of pain is typical, so it is important to distinguish between varicose veins and hernias in order to avoid unnecessary surgery. 2 Color Doppler ultrasound is the diagnostic of choice since it avoids the use of ionizing energy during 1 General Surgery Resident at the Postgraduate School of Naval Sanity, Universidad Naval and the Hospital General Naval de Alta Especialidad (HOSGENAES), Secretaría de Marina Armada de México (SEMAR) 2 Gynecology and Obstetrician Resident at the Postgraduate School of Naval Sanity, Universidad Naval and the Hospital General Naval de Alta Especialidad (HOSGENAES), Secretaría de Marina Armada de México (SEMAR) 3 General Surgery Service of the Tampico Naval Regional Hospital, Secretaría de Marina Armada de México (SEMAR) 4 Chief of the General Surgery Service of the Hospital General Naval de Alta Especialidad (HOSGENAES) and Associate Professor of the General Surgery Course in the Postgraduate School of Naval Sanity, Universidad Naval, Secretaría de Marina Armada de México (SEMAR) 5 General Surgery Service of the Hospital General Naval de Alta Especialidad (HOSGENAES), Secretaría de Marina Armada de México (SEMAR) pregnancy and is not only useful for the diagnosis of RLV, but also used for the follow-up of patients to exclude complications of RLV, such as rupture and thrombosis of the RLV that can produce and give rise to an intense painful inflammation in the groin. 3,4 This study is performed initially in the supine position and the Valsalva maneuver is important in this examination because the venous flow can decrease at rest.…”

“…3,4 This study is performed initially in the supine position and the Valsalva maneuver is important in this examination because the venous flow can decrease at rest. 1,3…”