Gonadal vein phlebolith simulating a midureteral stone

American Journal of Roentgenology (Impact Factor: 2.73). 12/1979; 133(5):919-20. DOI: 10.2214/ajr.133.5.919
Source: PubMed


Phleboliths most commonly form in the veins of the pelvis and are readily diagnosed as such. This paper presents a patient in whom a single phlebolith in the suprapelvic segment of the right ovarian vein was mistaken for a midureteral stone.

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    ABSTRACT: The preliminary radiographs of 783 patients undergoing excretory urography were prospectively surveyed for the presence of abdominally located phleboliths. Two per cent demonstrated typical densities in a periureteral distribution flanking the lumbar spine where they could be confused with ureteral calculi. All these patients were multiparous females and three-quarters of them had pelvic masses (11% of all patients with pelvic masses), suggesting a possible association with gonadal vein thrombi. Altered venous flow with dilatation of ovarian veins, consequent valvular incompetence and stasis may account for the gonadal vein distribution in the pelvic mass cases. Other observed clinical conditions included hepatic disease, portal hypertension and varices. Obstruction and stasis of venous flow in hepatic disease states may lead to phlebolith formation in gastric and mesenteric varices. Unlike pelvic phleboliths, suprapelvic phleboliths are infrequent but may be detected by careful inspection of low kilovoltage films, particularly in the regions closely flanking the lumbar spine. Their presence may be associated with pelvic masses or significant chronic hepatic disease and they may be confused on plain film with ureteral calculi.
    No preview · Article · Dec 1983 · Clinical Radiology
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    ABSTRACT: A wide variety of calcifications may develop in the urinary tract. Calculi, the most common form of urinary tract calcification, are usually radiopaque due to their calcium content, whereas cystine stones tend to be less opaque. In cortical nephrocalcinosis, calcification may be spotty or may appear as a thin rim outlining the cortex. Intracystic calcification is usually thin and peripheral and is often described as having an "eggshell" appearance. In renal masses, pure central calcification usually indicates malignancy, although malignancy may also be present with pure peripheral calcification. An incomplete ring of calcification seen over the central portion of the kidney should suggest the presence of an abnormal vascular structure. A sloughed papilla may lead to calcification that is usually triangular or ring-shaped or has a broken rim pattern. Ureteral calculi usually have a uniform radiopacity, whereas phleboliths are often less opaque centrally. Like renal calculi, bladder calculi usually contain a calcium component; they may be laminated, faceted, spiculated, or seedlike in appearance. Urachal carcinoma is commonly associated with tumor calcification, which typically occurs at the dome of the bladder. Schistosomiasis of the bladder may produce mural calcification with a typical thin arcuate pattern and may be associated with calcification in other portions of the urinary tract. Although urinary tract calcifications may be difficult to characterize specifically, they can be classified according to location, appearance, and relation to various pathologic conditions.
    Full-text · Article · Nov 1998 · Radiographics
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    ABSTRACT: On radiographs of the abdomen and pelvis, phleboliths often have a characteristic radiolucent center that helps to distinguish them from ureteral stones. On unenhanced CT, the distinction between pelvic phleboliths and distal ureteral stones can be problematic. The objective of this study was to compare the appearance of phleboliths on routine clinical CT studies with their appearance on radiography and to determine if the radiolucent center seen on radiographs is revealed on CT. During a 3-month interval, we identified 50 patients with acute flank pain who underwent both unenhanced CT and abdominal radiography. Patients with a radiograph of the pelvis and an unenhanced CT scan obtained within 1 month of each other were included. CT was performed with a collimation of 5 mm and a pitch of 1. Each phlebolith was examined using soft-tissue and bone settings and was also retrospectively pixel mapped. Seventy-nine (66%) of 120 phleboliths revealed radiolucent centers on abdominal radiography. On CT, 119 (99%) of 120 phleboliths failed to reveal a low-attenuation center on both visual inspection and pixel mapping. Pelvic phleboliths were shown to lack a radiolucent center on routine clinical CT examinations despite their appearance on radiography. A radiolucent center therefore cannot be used to differentiate phleboliths from distal ureteral stones on unenhanced CT in patients with acute flank pain and suspected ureteral obstruction.
    Preview · Article · Feb 1999 · American Journal of Roentgenology
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