PMC6712551_01
A 35-year-old postpartum woman presenting with a right groin mass due to a thrombosed round ligament varicosity. (a) Axial non-contrast computed tomography (CT) scan of the pelvis at the groin level shows a hyperdense serpentine structure (white arrow), extending from the right deep inguinal ring along the inguinal canal to the labia majora compatible with a round ligament varicosity. Surrounding fat stranding is present due to thrombosis. (b) Axial contrast-enhanced CT scan of the pelvis at the groin level shows a lack of enhancement of the round ligament varicosity, supporting the presence of thrombosis. (white arrow). (c) Coronal contrast-enhanced CT again illustrates the thrombosed right round ligament varicosity in the right groin with better demonstration of its course in the inguinal canal (white solid arrow). The gravid uterus (white-dashed arrow) is seen.
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F1
The CT demonstrated a hyperdense, mildly enhancing serpentine tubular structure extending from the right adnexa into the inguinal canal and down to the right labia majora with surrounding fat stranding [Figure 1a-c].
A 35-year-old postpartum woman presenting with a right groin mass due to a thrombosed round ligament varicosity. (a) Grayscale USG of the right groin shows multiple hypoechoic serpentine structures (white arrows) in the subcutaneous layer with "a bag of worm" appearance, compatible with round ligament varicosity. (b) Corresponding color Doppler ultrasound of the right groin mass shows absence of Doppler signal within the vessels (white arrows) which suggest the presence of thrombosis.
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F2
Supplementary ultrasound was performed for correlation, which showed multiple hypoechoic serpentine structures with a "bag of worm appearance" in the right inguinal region [Figure 2a]. No flow signal was detected on color Doppler [Figure 2b].
Six weeks after initial presentation and treatment with enoxaparin, there was clinical resolution of the right groin mass in this 35-year-old postpartum woman. On this color Doppler ultrasound image, the round ligament veins are no longer dilated. The presence of flow signal (white arrows) within the veins suggests recanalization and resolution of varicosity.
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F3
Reestablishment of flow signal within the residual veins suggested recanalization of the previously thrombosed veins [Figure 3].