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Round ligament of uterus

The round ligament of the uterus is a cord-like fibromuscular structure that helps maintain the anteverted position of the uterus. It extends from the uterine horns to the labia majora, passing through the inguinal canal. The ligament is clinically significant due to its association with groin pain during pregnancy, uterine support, and as a landmark in gynecological and laparoscopic surgery.

Synonyms

  • Ligamentum teres uteri

  • Uterine round ligament

  • Female gubernaculum remnant

Origin, Course, and Insertion

  • Origin: Arises from the anterosuperior surface of the uterus, just below and in front of the origin of the uterine tubes (uterine horns)

  • Course:

    • Passes laterally within the broad ligament

    • Enters the deep inguinal ring and traverses the inguinal canal

    • Emerges at the superficial inguinal ring

  • Termination: Inserts into the labia majora and blends with subcutaneous tissue

Relations

  • Medially: Uterus and uterine tubes

  • Laterally: Pelvic sidewall, covered by broad ligament

  • Within inguinal canal: Lies anterior to the round ligament artery and veins

  • Anteriorly: Abdominal wall structures

  • Inferiorly: Labia majora and mons pubis

Function

  • Helps maintain the anteverted and anteflexed position of the uterus

  • Provides passive support to the uterus within the pelvis

  • Serves as a landmark in gynecologic surgery (laparoscopy, open pelvic procedures)

  • Has clinical importance during pregnancy due to round ligament pain

Clinical Significance

  • Round ligament pain: Common in pregnancy due to stretching of the ligament

  • May mimic inguinal hernia or appendicitis when inflamed

  • Important surgical landmark during hysterectomy and pelvic laparoscopy

  • Can be involved by tumors such as leiomyomas or endometriosis

  • Pathology may present as a palpable groin mass (round ligament fibroid)

MRI Appearance

T1-weighted images:

  • Appears as a thin cord-like structure with low-to-intermediate signal intensity

  • Fat along its course may provide contrast

T2-weighted images:

  • Normal ligament shows low signal intensity

  • Inflammatory or tumorous involvement may appear as focal bright signal intensity

STIR (Short Tau Inversion Recovery):

  • Normal ligament remains dark

  • Pathology (edema, inflammation, endometriosis, tumor) demonstrates bright hyperintensity

T1 Fat-Sat Post-Contrast:

  • Normal ligament enhances mildly or not at all

  • Tumors or inflammatory lesions show enhancement, sometimes nodular or heterogeneous

CT Appearance

Non-Contrast CT:

  • Usually not well visualized; seen as a thin soft tissue density structure

  • Round ligament masses (e.g., fibroids, endometriosis) may appear as soft tissue nodules along the inguinal canal

Post-Contrast CT:

  • Normal ligament shows little to no enhancement

  • Pathologic lesions (tumor, inflammation, endometriosis) may enhance and be differentiated from surrounding fat planes

MRI image

Round ligament of the uterus mri axial anatomy image 1

MRI image

Round ligament of the uterus mri axial anatomy image 2

MRI image

Round ligament of the uterus mri axial anatomy image 3

CT image

Round ligament of the uterus CT axial image image anatomy image

CT image

Round ligament of the uterus CT axial image image anatomy image