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Joseph Junewick, MD FACR
over 6 years ago
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Adnexal Varicosities

Case Detail

Anatomy: Vascular-Lymphatic
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 4 years ago
Updated: about 1 year ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

Teenage female with pelvic pain.


Case Images


Diagnosis

Left Adnexal Varicosities Secondary to Left Renal Vein Entrapment

Clinical Notes

Incidental 7 cm simple retrouterine cyst unrelated to ovaries.

Findings

CT – Serpiginous tubular enhancing structures in the left adnexa, normal ovaries and retrouterine cyst; note the marked compression of the left renal vein by the superior mesenteric artery and aorta.

Discussion

Anatomy of the pelvic venous outflow is variable. On the left, venous drainage from the pelvis is predominantly via the left ovarian vein and the left internal iliac vein. The left ovarian vein empties into the left renal vein. The left internal iliac venous plexus drains into the deep pelvic central veins. In females, there is venous communication between the ovarian veins and the internal iliac veins. In addition, there is flow across the midline to the contralateral side as well as communication with veins in the upper thighs, pelvic floor, and lower gastrointestinal tract. On the right side, venous drainage from the right ovarian vein empties into the central venous system generally at the junction of the inferior vena cava and the right renal vein. The right internal iliac vein is similar to the left in its pattern of venous communications. If the left common iliac vein may be compressed by the crossing right common iliac artery anteriorly and the lumbosacral skeletal structures posteriorly and result in obstruction (May-Thurner Syndrome).

Reference

Venbrux AC, Sharma GK, Timmreck E, et al. Pelvic Varices Embolization. Women’s Health in Interventional Radiology, 2012.



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