Ovarian ligament

Meiss RA (1993) Persistent mechanical effects of decreasing length during isometric contraction of ovarian ligament smooth muscle. J Muscle Res Cell Motil 14 205218 Meiss RA (1994) Transient length-related mechanical states in smooth muscle. Can J Physiol Pharmacol 72 13251333... 

Each ovary is suspended in the peritoneal cavity by three supporting structures the mesovarium which anchors the ovary to the posterior aspect of the broad ligament the ovarian ligament which attaches the ovary to the uterine cornu and the suspensory ligament or infundibulopelvic which anchors the ovary to the pelvic side wall [6]. 

The ovarian ligament and suspensory ligament are not tight supporting structures but more comparable to a mesentery [4]. The ovarian blood vessels and lymphatics course within the peritoneal folds of the mesovarium and enter and exit the ovary through the ovarian hilum. Anastomosing branches of the ovarian and uterine vessels in close relationship with lymphatics are located within the mesovarium [6]. 

The ovarian ligament is a rounded fibromuscular band extending from the ovary to the uterine cornu [6]. Its position varies with that of the ovary. It is located immediately posterior and inferior to the fallopian tube and round ligament [15]. The ovarian branches of the uterine artery pass through the ovarian ligament and anastomose with branches of ovarian artery in the mesovarium. 

The broad ligament and mesovarium are usually not discernible on cross-sectional imaging unless they are surroimded by large amounts of ascites. Its position, however, can be identified by the structures it contains [15]. In ascites, the ovaries can be seen suspended from the posterior surface of the broad ligament (Fig. 8.9) [4]. The ovarian ligament may occasionally be visualized as a short and narrow soft tissue band extending between the uterus and ovary (Fig. 8.10). 

Tracking these vessels continuously downwards from the retroperitoneum to the pelvis, leads to the suspensory ovarian ligament [ 11 ]. The latter is an excellent landmark for localizing the ovary (Fig. 8.11). It is a short, narrow fan-shaped soft tissue band that widens as it approaches the ovary. Sometimes it can also be identified as a linear band that is thicker than the ovarian vein. Due to its vascular landmarks it is more commonly identifiable than the other ovarian ligaments [4]. 

Fig. 8.10. Ovarian ligament on MRI. The right ovarian hga-ment is identified as a short band extending between uterus and ovary (arrow). The thickening of the endometrium is caused by endometrial cancer. A small amount of physiologic pelvic fluid is noted...

A mesothelial cyst in the round ligament has been attributed to ovarian stimulation (39). 

Apart from the classic pattern in which the uterine artery arises from the medial aspect of llA, there are many other variants that have been identified (please see Chap. 10.3). It may also arise from its anterior or lateral aspect of the IIA [18]. The origin of the uterine artery from the main IIA itself or from the aorta has also been described [18]. A common trunk between the uterine artery and vesical artery is another important variant that might lead to inadvertent vesical ischemia in cases of non-tar-geted embolization [19]. The uterine artery may also duplicate as illustrated by Redlich et al. [20]. The ovarian artery represents the second main vessel for PPH [21, 22]. The ovarian artery that participates in uterine blood supply could represent the major feeding vessel to the uterus as demonstrated in UFE literature [23] (Fig. 9.2). Recently, Saraiya et al. illustrated uterine artery replacement by the round ligament artery during embolization for leio-... 

LeDref 0, Pelage J, Kardache M et al. (2000) Superselec-tive embolization of ovarian and round ligament arteries in the management of obstetric menorrhage. Cardiovasc Intervent Radiol 23 103... 

There are some important anatomic variations associated with failure. These include tortuous artery, small uterine artery in one or both sides, absence of uterine arteries, ovarian artery supply of the fibroids and other less common variants such as a round ligament artery supply [7]. 

The uterine tubes lie on each side of the uterus in the upper margin of the broad Ugament (see Table 1.1 broad ligament). Each tube is attached on its inferior surface to a double fold of peritoneum called mesosalpinx (see Table 1.1). The lateral and superior part of the tube is the ampulla that opens into the funnel-shaped infimdibulum with its fimbria at the abdominal orifice. The ovaries lie in the ovarian fossa, i.e. close to the lateral pelvic wall and are suspended by a double fold of peritoneum, the mesovarium (see Table 1.1). The latter is attached to the broad ligament posteriorly. Behind the ovarian fossa are extraperitoneal structures, especially the ureter and the internal iliac vessels as well as the origin of the uterine artery (Fig. 1.14). 

The suspensory ligament of the ovary is located at the superior lateral aspect of the broad ligament [6]. It extends from the ovary anterolaterally over the external and common iliac vessels and blends with coimective tissue over the psoas muscle [15]. Ovarian blood vessels and lymphatics traverse the suspensory ligament to reach the ovarian hilum along the mesovarium. 

The ovarian artery originates from the lumbar aorta near the renal hilum. It is accompanied along its retroperitoneal course by the ovarian vein and the ureter on the anterior surface of the psoas muscle. It then crosses the ureter and common iliac vessels near the pelvic brim to enter the suspensory ligament of the ovary. The ovarian artery courses inferiorly and medially between the two layers of the broad ligament near the mesovarian border [4]. It forms multiple branches that reach the ovarian hilum via the mesovarium. It has a tortuous course that is most pronounced near the ovary. 

The ovarian lymphatics ascend with the ovarian vessels along the psoas muscle and drain almost exclusively into the para-aortal lymph nodes at the level of the lower pole of the kidneys. In some patients, accessory channels pass the broad ligament and drain into the internal and common iliac and interaortic... 

The paracolic gutters present a common location of ovarian maldescent above the pelvic hrim. After pregnancy the ovaries may he hindered from returning to their original position due to adhesions. Furthermore, an ectopic ovarian position may he associated with adhesions, inflammation, and surgery, or result from abnormal ovarian mobility due to elongation of the broad ligaments [4] (Fig. 8.14). 

Paraovarian cysts tend to be large thin-walled unilocular cysts, located typically within the broad ligament (Fig. 9.20). Rarely they may contain internal septa-tions. On CT and MRl, they display typical criteria of ovarian cysts, but are found separate from the ipsilateral ovary [55,58]. 

The solid morphology and the signal characteristics of fibromas and fibrothecomas are fairly characteristic. Pedunculated uterine fibroids and fibroids of the broad ligaments can display similar imaging characteristics. The latter can only be differentiated from ovarian fibromas or fibrothecomas when they are separated from the ovary. Subserosal pedunculated fibroids can be discrimi-... 

Primary ovarian cancers cannot be reliably differentiated from fallopian tube cancers however, the latter are exceedingly rare. In presence of associated hydrosalpinx, tubal cancer may mimic ovarian cancer with cystic and solid components. Especially with T2-weighted images, however, identification of the cystic areas representing the loops of the distended tube is usually possible. Metastases to the fallopian tubes, which result most commonly from direct extension of gynecologic cancers, cannot be reliably differentiated from primary fallopian tube cancers. Rarely, leiomyomas of the fallopian tube may be encountered, which resemble ovarian stromal tumors or fibroids of the broad ligament. 

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