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Broad ligament of uterus

The broad ligament of the uterus is a wide, double layer of peritoneum that extends from the lateral margins of the uterus to the lateral pelvic walls. It acts as a mesentery for the uterus and associated structures, providing support and serving as a conduit for vessels, nerves, and lymphatics. It plays a crucial role in gynecological anatomy and surgery, particularly in hysterectomy and adnexal procedures.

Synonyms

  • Uterine broad ligament

  • Lateral uterine ligament

  • Peritoneal fold of uterus

Parts

The broad ligament is divided into specific regions based on the structures enclosed:

  • Mesometrium: Largest portion, extending from the uterus to the pelvic sidewall; contains uterine vessels

  • Mesosalpinx: Superior portion that encloses the fallopian tube

  • Mesovarium: Small fold that attaches the ovary to the posterior surface of the broad ligament

  • Suspensory ligament of the ovary (infundibulopelvic ligament): Often considered part of the broad ligament, carrying ovarian vessels

Contents

  • Fallopian tube (within mesosalpinx)

  • Round ligament of the uterus

  • Ovarian ligament

  • Uterine and ovarian vessels with accompanying lymphatics

  • Nerves (autonomic fibers to uterus, ovaries, and tubes)

  • Loose connective tissue and lymph nodes

Relations

  • Anteriorly: Bladder (via vesicouterine pouch)

  • Posteriorly: Rectum and rectouterine pouch (pouch of Douglas)

  • Superiorly: Encloses fallopian tube

  • Inferiorly: Extends to the pelvic floor, continuous with connective tissue of cervix and vagina

  • Laterally: Pelvic sidewall, enclosing uterine vessels near their origin from internal iliac artery

Function

  • Provides support to uterus, fallopian tubes, and ovaries

  • Acts as a mesentery for uterine adnexa, transmitting blood vessels, lymphatics, and nerves

  • Helps maintain position of the uterus within the pelvis

Clinical Significance

  • Site of spread for infections and tumors of uterus, tubes, and ovaries

  • Broad ligament cysts may develop, usually benign but can mimic adnexal pathology

  • Pelvic surgeons use it as a surgical landmark during hysterectomy, oophorectomy, and tubal surgeries

  • In advanced cancers, broad ligament infiltration affects staging and management

MRI Appearance

T1-weighted images:

  • Appears as a thin, low-signal peritoneal fold

  • Fat and vessels within the ligament appear as higher signal areas

T2-weighted images:

  • Ligament itself remains low signal

  • Cysts or fluid collections appear bright

  • Pathological thickening appears as intermediate-to-high signal intensity

STIR (Short Tau Inversion Recovery):

  • Broad ligament itself remains dark

  • Inflammatory or edematous changes appear bright

  • Cystic lesions demonstrate high signal intensity

T1 Fat-Sat Post-Contrast:

  • Normal ligament enhances minimally

  • Tumors, infiltrations, or inflammatory processes demonstrate heterogeneous enhancement

  • Broad ligament cysts typically show no enhancement or only rim enhancement if complicated

CT Appearance

Non-Contrast CT:

  • Ligament is not well seen as a discrete structure; visualized by displacement of fat and pelvic organs

  • Broad ligament cysts appear as well-circumscribed, fluid-density lesions

  • Masses may cause thickening or asymmetry of the broad ligament region

Post-Contrast CT:

  • Vessels and connective tissue within the broad ligament enhance mildly

  • Pathological involvement (tumor, inflammation) appears as irregular or nodular enhancement

  • Cysts remain low density without enhancement

MRI images

broad ligament of uterus mri axial image image anatomy image-img-00000-00000