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Uterine veins

The uterine veins are paired venous channels responsible for the venous drainage of the uterus. They arise from the uterine venous plexus, a rich network surrounding the uterus, cervix, and upper vagina. These veins accompany the uterine arteries in the broad ligament and ultimately drain into the internal iliac veins.

They are clinically important in pregnancy, postpartum hemorrhage, uterine pathology, and pelvic venous disorders. On imaging, their recognition is essential to evaluate vascular causes of pelvic pain, tumors, and varicosities.

Synonyms

  • Veins of the uterus

  • Uterine venous plexus tributaries

  • Uterine venous drainage

Origin, Course, and Drainage

  • Origin: Arise from the uterine venous plexus around the uterus and cervix

  • Course:

    • Form a plexiform network along the sides of the uterus within the broad ligament

    • Run parallel to the uterine arteries, enclosed within connective tissue

    • Course laterally toward the pelvic wall

  • Drainage:

    • Empty into the internal iliac veins (main drainage)

    • Communicate with the ovarian veins superiorly and the vaginal venous plexus inferiorly

Relations

  • Anteriorly: Bladder and vesicouterine pouch

  • Posteriorly: Rectouterine pouch (pouch of Douglas) and rectum

  • Laterally: Broad ligament, uterine artery, ureter

  • Inferiorly: Vaginal venous plexus

Function

  • Venous drainage of the uterus, cervix, and upper vagina

  • Provides collateral circulation with ovarian and vaginal veins

  • Plays a role in uterine hemodynamics during pregnancy and menstruation

Clinical Significance

  • Postpartum hemorrhage: Major source of bleeding in uterine atony or trauma

  • Pelvic congestion syndrome: Dilated uterine and ovarian veins may cause chronic pelvic pain

  • Tumor spread: Uterine malignancies can spread via venous pathways

  • Surgical relevance: Important to control during hysterectomy or uterine surgery

  • Thrombosis: Rare but may occur postpartum or with pelvic infection

MRI Appearance

T1-weighted images:

  • Veins appear as flow voids (dark linear/tubular structures)

  • Thrombosed veins may appear as intermediate-to-high signal intensity depending on clot stage

  • Surrounding fat appears bright, helping identification

T2-weighted images:

  • Normal patent veins show flow voids (dark signal)

  • Slow flow or dilated veins may appear as bright hyperintense channels

  • Thrombosis appears as variable high signal depending on clot age

STIR (Short Tau Inversion Recovery):

  • Suppresses fat, making veins more conspicuous

  • Flow voids appear dark; thrombosed/dilated veins appear bright

T1 Fat-Sat Post-Contrast:

  • Normal veins enhance briskly and homogeneously

  • Thrombosed veins show lack of enhancement or peripheral rim enhancement if inflamed

  • Dilated uterine veins in pelvic congestion show marked enhancement

3D T2 SPACE / CISS:

  • Veins appear as flow voids or mildly hyperintense tubular structures depending on flow velocity

  • Excellent for mapping venous plexus anatomy in 3D

CT Appearance

Non-Contrast CT:

  • Veins are not well visualized unless thrombosed or dilated

  • Thrombosis may appear as hyperdense tubular structure within the broad ligament

Post-Contrast CT:

  • Veins opacify early and drain into internal iliac veins

  • Dilated uterine veins in pelvic congestion appear as tortuous, enhancing channels

  • Thrombosed veins show filling defects within enhancing venous structures

MRI image

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MRI image

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MRI image

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CT image

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CT image

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