British Journal of Radiology (2007) 80, 588-589
© 2007 British Institute of Radiology
doi: 10.1259/bjr/63118673
Groin mass in pregnancy
I G Murphy, MB, BCh, MRCS1,
E J Heffernan, MB, FFR, RCSI2 and
R G Gibney, MB, FFR, RCSI2
1 Surgical Professorial Unit, 2 Department of Radiology, St Vincent's University Hospital, Dublin 4, Ireland
Correspondence: I Murphy, Department of Surgery, St Vincent's University Hospital, Dublin 4, Ireland. E-mail: iangmurphy{at}gmail.com
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Introduction
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Here, we report a case of a 37-year-old woman who presented at 28 weeks gestation with a lump over the left pubic tubercle. The lump was first noticed 3 weeks previously and was causing discomfort, which became worse after standing. This was her second pregnancy and no similar lump had developed during the previous pregnancy. On examination, she had a swelling 4 cm in size overlying the lower half of the left inguinal ligament. There was also a smaller corresponding lump on the right-hand side. The swelling was reducible and had a cough impulse; it was prominent while standing, but disappeared with the patient recumbent. There was no evidence of venous insufficiency of the lower limbs. An ultrasound was performed (Figure 1
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Figure 1. (a) Greyscale sonography showed a 4 cm soft-tissue mass in the left groin composed of multiple echo-free serpentine tubular channels that filled with colour on (b) colour-flow imaging. The lesion was soft and compressible. A smaller (2 cm) similar lesion was present in the right groin.
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What findings are demonstrated? What is your diagnosis?
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Discussion
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Varicocoele of the round ligament is a rare clinical entity with only sporadic reports in the medical literature [1, 2, 3]. It is associated with (i) pregnancy; (ii) the onset of a groin swelling typically early in the third trimester; (iii) progressive enlargement during pregnancy; and (iv) regression soon after delivery [2, 3], as in our patient.
The round ligament passes from the pelvis, through the internal abdominal ring, and along the inguinal canal to the labia majora. The varicocoele arises from the veins draining the round ligament and the inguinal canal. It appears to be associated with ovarian and pelvic venous engorgement in pregnancy, but not with lower limb varicosities [3].
An ultrasound scan can help to clarify the nature of clinically indeterminate groin swellings [4]. The lesions most commonly encountered include hernia, lymphadenopathy, lipoma, abscess, haematoma, pseudoaneurysm and thrombophlebitis. The classic ultrasound appearance of varicocoele is well described for other parts of the body [5] and, although very rare, its use has been documented in the literature [6].
In previous reports [1, 2], patients with varicocoele of the round ligament have been subjected to surgery because of the difficulty in making an accurate diagnosis. A combination of clinical suspicion and typical sonographic appearances enables a confident diagnosis and appropriate conservative management [6].
Received for publication August 10, 2005.
Revision received December 8, 2005.
Accepted for publication January 12, 2006.
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References
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- Egan JJ. Varicocoele of the round ligament. J Ir Med Assoc 1967;60:472–3.[Medline]
- McLaren CA, Brown PW. Varicocoele in the female. J R Coll Surg Edinb 1983;28:125[Medline]
- Reisfield DR. Varicosities in veins of the inguinal canal during pregnancy. J Med Soc N J 1962;59:24–6.[Medline]
- Deitch EA, Soncrant MC. Ultrasound diagnosis of surgical diagnosis in the inguino-femoral region. Surg Gynecol Obstet 1981;152:319–22.[Medline]
- Rifkin MD, Foy PM, Kurtz AB, Pasto ME, Goldberg BB. The role of diagnostic ultrasonography in varicocele evaluation. J Ultrasound Med 1983;2:271–5.[Abstract]
- Cheng D, Lam H, Lam C. Round ligament varices in pregnancy mimicking inguinal hernia: an ultrasound diagnosis. Ultrasound Obstet Gynecol 1997;9:198–9.[CrossRef][Medline]
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Introduction
Discussion
