Pelvic phleboliths as a diagnostic challenge for the ultrasound specialist
Olga Pushkarenko, Uzhhorod National University, Poland
Objectives
Phleboliths are calcified intravenous blood clots that may result from changes in coagulation or fibrinolytic activity, from local venous damage, or a combination of these factors. They may mimic ureteric calculi, and are also encountered frequently in venous malformations. The purpose of our presentation of the clinical case is to highlight the value of ultrasound in the differential diagnosis of pelvic phleboliths.
Methods
Ultrasound examination was performed on a Canon Aplio machine using B-mode, Doppler, convex, linear and endocavitary probes.
Results
A 72-year-old woman was admitted to hospital with suspected stones in the distal left ureter. There were no significant medical conditions. History of varicose veins of the lower extremities, post thrombophlebotic syndrome, analysis of urine without changes. Transabdominal examination using a convex probe did not identify dilatation of the urinary collecting system, and urine was present in the bladder. Transvaginal examination showed both distal ureters were empty, but the pelvic venous plexus on the left contained several hyperechoic round inclusions (ring-calcified lesion) with acoustic shadowing and approximate diameters of 3 to 7 mm. Polypositional scanning and Doppler examination allowed us to reliably verify the presence of phleboliths.
According to the literature, such a finding is diagnosed incidentally and does not require treatment. These lumps are more common in women aged over 40 and are associated with constipation and straining, which can damage pelvic veins, diverticulosis, varicose veins, and pregnancy. Histologically, phleboliths are composed of small blood clots in a vein that harden over time due to formation of laminated fibrous tissue and calcification.
Conclusions
There are many cases of diagnostic errors and repeated examinations for the differential diagnosis of phleboliths and stones in the urinary tract. Transvaginal or transrectal visualisation is a highly specific method for clarification and a good alternative to X-ray, MRI and CT examination.