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Round Ligament Varicosities

More Swelling

Step 1: View clinicals

A 29 year old lady in her second pregnancy presents at 36 weeks of gestation with a palpable mass in her right groin for two weeks, which has slowly increased in size. There was no associated abdominal pain, while her bowel habits were unaltered. Her pregnancy was otherwise unremarkable so far. Her first pregnancy was uneventful.

Step 2: Order all relevant investigations

Ultrasound Abdomen

There is a 2.5 x 3 cm mass in the right groin, with a prominent venous plexus and multiple dilated draining veins. There is no sonographic evidence of herniated bowel or lymph nodes.

Color Doppler of Mass

The mass is hypervascular, with abundant venous flow, which is augmented by the valsalva maneuver. The veins are noted to drain into the inferior epigastric vein.

CT Angiography

You recall that intravenous contrast agents are best avoided during pregnancy.

Transvaginal Ultrasound

A single fetus in the left anterior position is seen; the placenta is located posteriorly; an adequate amount of amniotic fluid is present, with an amniotic fluid index (AFI) of 8.0.

Step 3: Select appropriate management

Surgical Exploration
Urgent LSCS
Monitor with Ultrasound

Score: ★★☆