Bilateral round ligament varicosities mimicking an inguinal hernia in pregnancy: Case report

Abstract

A 22-year-old pregnant woman presented with a painful swelling in the right groin. Sonography was performed to confirm a presumptive diagnosis of inguinal hernia based on physical examination. Gray-scale sonography examination revealed bilateral inguinal cystic lesion expanding with the Valsalva maneuver. Color Doppler imaging demonstrated multiple prominent vessels with retrograde venous flow during Valsalva maneuver. Bilateral round ligament varicosities were diagnosed and inguinal hernia was excluded by sonographic findings. Round ligament varicosities should be considered in the differential diagnosis of groin swelling during pregnancy.

Round ligament varicosities associated with uterine varicosities in pregnancy: A case report

“…The characteristic US appearance of RLVs is the presence of multiple dilated veins passing through the inguinal canal, veins draining into the inferior epigastric vein, and absence of bowel loop or lymphadenopathy in the inguinal mass. Color Doppler imaging and spectral Doppler analysis confirm venous flow and augmentation with Valsalva maneuver . In this case, a rare finding was the presence of varices on the surface of uterus and of dilated veins in the myometrium.…”

“…As documented previously, US leads to the correct diagnosis . The characteristic US appearance of RLVs is the presence of multiple dilated veins passing through the inguinal canal, veins draining into the inferior epigastric vein, and absence of bowel loop or lymphadenopathy in the inguinal mass.…”

“…Although RLVs during pregnancy have been reported previously, RLVs associated with uterine varicosities are rare. Characteristics of 24 cases of RLV reported in the literature, including the present one, are shown in Table . The clinical manifestations usually include a tender mass in the groin region, which can be provoked by increasing the intra‐abdominal pressure, e.g., by coughing, standing, or performing Valsalva maneuver.…”

“…RLVs could be misdiagnosed as an inguinal hernia . A painful irreducible inguinal mass could suggest a strangulated or incarcerated inguinal hernia that requires emergency surgery . On US a hernia will appear with peristalsis, mucosal blood flow, or mesenteric fat.…”

“…Round ligament varicosities (RLVs) are relatively uncommon during pregnancy . These distended veins in the round ligament are often accompanied by vulvar and lower limb varices.…”