MyPACS.net: Radiology Teaching Files > Case 24649607

previously visited ADNEXAL VERICOCELE
Contributed by: sabrina antosh, Triton College, River Grove, IL, USA, Illinois, USA.
Patient: 80 year old female
History: 80 year old female. Pelvic pain and urinary urgency.
Images:[small]larger

Fig. 1: The uterus is shown atrophic and retroverted.

Fig. 2: The left ovary in trans.

Fig. 3: The left ovary in long.

Fig. 4: Dilated and sausage shaped structure.

Fig. 5: Color Doppler was performed.

Fig. 6: Color Doppler is shown.

Fig. 7: Color Doppler was placed through out the structure.

Fig. 8: Primarily anechoic structure is seen in the left adnexa.

Fig. 9: The mass is seen in long with the dilated tubular structure.

Fig. 10: Color was added to show vascularity in the sausage shaped structure and to show no vascularity in the left adnexal mass.
Findings: The uterus is post-menopausal, retroverted, and atrophic. A very dilated, serpiginous, sausage shaped, tubular structure within the left adnexa is noted. The left ovary contains a primarily anechoic, irregular structure with internal echoes and septations measuring 1.8 x 1.6 x 1.2 cm. This was best seen transvaginally.
Diagnosis: The sausage like structure is a vericocele which was proven with color Doppler. The structure measured in the left ovary is classified as a complex cystic mass.
Discussion: A varicocele in woman is the "dilation of the broad ligament and ovarian plexus veins and the presence of an incompetent ovarian vein." A valve most likely stops working correctly and reflux occurs. The varicocele can form around the ovary and spreads into the pelvis area. The dilated vein can push further into the pelvis and apply pressure on the bladder; this is why there may be urinary urgency. This will iritate the bladder as well as the bowel. Etiology is still not clear. Possible hormonal factors can contribute. An example would be estrogen (estrogen is a vasodilator). A vericocele, found in women, is a rare occurence happening in only about 10% of the general female population. Patients can be asymptomatic, have pelvic pain, dyspareunia, have urinary urgency, or painful menstruation. Transvaginal ultrasound is the modality of choice to diagnose this. "Embolization or ligation of the ovarian vein shows good results in ovarian vericocele. In addition to ligation of the uterine veins, which are in relation to the ovarian vein, varicectomy to vulvar and leg varices yields good outcomes." Statistics show a huge relationship to lower limb insufficiency with the presence of a vericocele. If there is lower limb insufficiency, it should be treated.
References: Case contributed by: Luthern General Hospital; Park Ridge, IL. The Whiteley Clinic. Ovarian Veins in Woman. Available at www.vulval-varicose-veins.co.uk/ovarian_veins.htm. Accessed on Feb. 22, 2009. Diagnostic and Interventional Radiology Official Journal of the Turkish Society of Radiology. The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women. Available at http://www.dirjournal.org/text.php3?id=60. Accessed on Feb. 22, 2009.
Comments:
No comments posted.
Additional Details:

Case Number: 24649607Last Updated: 03-22-2009
Anatomy: Other   Pathology: Vascular
Modality: USAccess Level: Readable by all users
Keywords: vericocele, ovarian

The reader is fully responsible for confirming the accuracy of this content.
Text and images may be copyrighted by the case author or institution.
You can help keep MyPACS tidy: if you notice a case which is not useful (e.g. a test case) or inaccurate, please contact us.