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Left ovarian vein

The left ovarian vein is a paired venous structure that drains blood from the ovary and adnexa into the left renal vein. It originates from the ovarian venous plexus in the broad ligament of the uterus, which communicates with the uterine venous plexus, pampiniform plexus, and tubal veins. The vein ascends in the retroperitoneum alongside the ovarian artery, crosses anterior to the psoas muscle and ureter, and drains into the left renal vein at a right angle, just before the renal vein enters the inferior vena cava.

Anatomical differences exist between the two ovarian veins: the left ovarian vein drains into the left renal vein, while the right ovarian vein drains directly into the inferior vena cava (IVC). The left-sided drainage at a perpendicular angle predisposes it to higher intraluminal pressure and venous incompetence, contributing to pelvic congestion syndrome in women.

Clinically, the left ovarian vein is significant in pelvic varices, chronic pelvic pain, infertility, ovarian vein thrombosis, and varicocele formation (in males, via its homologue, the left testicular vein). It is also important in interventional radiology, where ovarian vein embolization is performed to treat pelvic congestion syndrome.

Synonyms

  • Vena ovarica sinistra

  • Left gonadal vein

  • Left female gonadal vein

Function

  • Drains blood from the ovary, uterine adnexa, and pampiniform plexus

  • Provides collateral venous communication with the uterine and vaginal venous systems

  • Contributes to venous return via the left renal vein → IVC

  • Plays a key role in pathophysiology of pelvic congestion syndrome

MRI Appearance

T1-weighted images:

  • Normal vein appears as a flow void (dark lumen) along its retroperitoneal course

  • Thrombosed vein appears as an intermediate-to-high intraluminal signal depending on clot age

T2-weighted images:

  • Flowing blood shows as a signal void

  • Thrombosis appears hyperintense if subacute, hypointense if chronic with fibrosis

STIR:

  • Suppresses surrounding retroperitoneal fat, improving contrast of the ovarian vein

  • Highlights perivenous edema or inflammatory changes as hyperintense areas

T1 Fat-Saturated (Pre-contrast):

  • Lumen shows intermediate signal intensity, standing out against suppressed fat

  • Useful for identifying vein caliber and intraluminal abnormalities

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Normal vein enhances brightly and homogeneously

  • Thrombus is seen as a filling defect

  • Useful in confirming venous incompetence, varices, or collateral drainage

MRV (Magnetic Resonance Venography):

  • Clearly demonstrates the left ovarian vein course and drainage into the left renal vein

  • Defines venous dilatation and reflux in pelvic congestion syndrome

  • Useful for pre-embolization mapping

CT Appearance

CT Pre-Contrast:

  • Vein appears as a tubular soft-tissue density along retroperitoneum, often difficult to separate from fat without contrast

  • Acute thrombus may appear hyperdense

CT Post-Contrast:

  • Left ovarian vein enhances with contrast, draining into left renal vein

  • Thrombosis identified as a non-enhancing intraluminal filling defect

  • Surrounding inflammatory changes may be seen in ovarian vein thrombophlebitis

CTV (CT Venography):

  • Provides high-resolution evaluation of left ovarian vein anatomy and pathology

  • Demonstrates dilatation, reflux, thrombus, or varices

  • 3D reconstructions useful for embolization planning and surgical mapping

CT images

Left ovarian vein ct axial 1

CT images

Left ovarian vein ct axial 2

CT images

Left ovarian vein ct coronal

CT images

Left ovarian vein

MRI images

Left ovarian vein MRI coronal anatomy image -img-00000-00000