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Uterine venous plexus

The uterine venous plexus is an extensive venous network located around the uterus, formed by numerous interconnecting veins that accompany the uterine artery and its branches. It lies mainly along the lateral surfaces of the uterus within the broad ligament, and communicates with the ovarian venous plexus, vaginal venous plexus, vesical plexus, and rectal venous plexus.

Blood from the uterine venous plexus drains into the uterine veins, which then empty into the internal iliac veins. This plexus plays an important role in uterine circulation, pregnancy-related adaptations, and pelvic venous return.

Clinically, it is significant because of its involvement in pelvic congestion syndrome, varices, uterine fibroid vascularity, postpartum hemorrhage, and pathways for tumor spread.

Synonyms

  • Plexus venosus uterinus

  • Uterine veins network

  • Part of the pelvic venous plexus

Function

  • Provides venous drainage of the uterus and endometrium

  • Forms extensive anastomoses with ovarian, vaginal, vesical, and rectal venous plexuses

  • Acts as a collateral circulation network during pregnancy and venous obstruction

  • Clinical role in pelvic varices, hemorrhage control, and uterine tumor spread

MRI Appearance

T1-weighted images:

  • Venous plexus: linear/tubular hypointense structures along the uterine margin

  • Surrounded by intermediate signal uterus and fat

T2-weighted images:

  • Flowing blood: signal voids within tortuous venous channels

  • Dilated varices: multiple round or tubular flow voids clustered around uterus

  • Thrombosis: hyperintense lumen with absent flow void

STIR:

  • Fat suppression highlights perivenous edema or engorged plexus

  • Enlarged uterine varices: appear bright tubular structures in pelvis

T1 Fat-Suppressed Post-Gadolinium:

  • Normal plexus: bright homogeneous venous enhancement

  • Varices: dilated, tortuous enhancing channels

  • Thrombosis: non-enhancing filling defects in otherwise enhancing venous plexus

MRV (Magnetic Resonance Venography):

  • Normal signal: flowing venous blood appears bright hyperintense

  • Varices: multiple dilated hyperintense tortuous channels around uterus

  • Thrombosis: hypointense, non-enhancing filling defects

  • Excellent for mapping pelvic venous reflux and uterine varices in pelvic congestion syndrome

CT Appearance

Non-contrast CT:

  • Plexus may be faintly seen as soft-tissue tubular densities along uterus

  • Difficult to evaluate without contrast

CT Post-Contrast:

  • Venous plexus enhances, appearing as multiple enhancing venous channels lateral to uterus

  • Detects engorgement, varicosities, or compressive pathology

CTV (CT Venography):

  • Normal signal: venous plexus lumen opacifies as bright hyperdense channels

  • Varices: dilated, tortuous, densely opacified veins encircling uterus and broad ligament

  • Thrombosis: intraluminal hypodense filling defects in otherwise enhancing veins

  • Provides excellent mapping of uterine venous drainage, pelvic varicosities, and collateral pathways

Clinical Significance

  • Pelvic congestion syndrome: Engorgement of uterine and ovarian venous plexuses causes chronic pelvic pain, dyspareunia, and varices.

  • Postpartum hemorrhage: Venous plexus can contribute to massive bleeding.

  • Fibroids and tumors: Venous engorgement occurs in hypervascular fibroids and malignant spread.

  • Oncology: Serves as a route for metastatic spread of uterine and pelvic malignancies.

  • Surgical relevance: Must be preserved or ligated properly during hysterectomy, myomectomy, or embolization procedures.

MRI image

Uterine venous plexus MRI axial anatomy image-img-00000-00000

CT image

Uterine venous plexus ct axial anatomy image-img-00000-00000