Phleboliths In The Pelvis

Phleboliths are extremely common findings on X-rays and CT.   These small calcifications are most commonly found in the pelvis.  They are usually less then a centimeter.  They look like small white spots or calcifications.  They are important to distinguish from other calcifications in the pelvis such as passing kidneys stones.

What are pelvic phleboliths?

These are small calcifications in the pelvis under a centimeter.  They arise from small veins in the pelvis.  Phleboliths form when small clots form in these veins and undergo hardening and calcification.

What do pelvic phleboliths look like?

They are usually small white spots or calcifications, most common in the pelvis.  They are often rounded and can be clustered.

Why do I have pelvic phleboliths?

They are thought to form when there is damage to the lining of the veins in the pelvis.  This causes small clots to form which harden over time.  This can occur from coughing and straining.

Are pelvic phleboliths dangerous?

No.  They usually have no clinical relevance.  Meaning they can be  ignored.  They also do not require treatment in most cases.

Can pelvic phleboliths look like a passing kidney stone?

Yes. Pelvic phleboliths can look like kidney stones passing into the ureters.  On X-ray, phleboliths can be distinguished from passing kidney stones by their appearance and location in many cases.

Phleboliths will sometimes have lucent or dark centers.  CT can also help because they will tell us the exact location of the phlebolith in relation to the ureter.

A passing stone will also often show an obstructed kidney with a dilated collecting system.  A phlebolith does not obstruct the kidney because it forms in the small veins of the pelvis.

What else can pelvic phleboliths look like?

Phleboliths can also mimic other calcifications in some cases such as bladder stones.  Usually bladder stones are larger.  In difficult cases, an ultrasound or CT of the bladder can be performed.

Phleboliths can also mimic calcifications in the prostate.  This does not matter because prostate calcifications are not significant in many cases.

Small calcifications can sometimes be seen in pelvic masses.   The masses will not be seen on X-rays however, only the calcifications.  Therefore tumor calcifications can sometimes be mistaken for benign phleboliths.

Small calcifications in the pelvis can sometimes be found in the appendix indicating an appendicolith.   These can obstruct the appendix and cause appendicitis.  Phleboliths in the right pelvis can mimic an appendicolith.

Some venous malformations can have multiple phleboliths. This is an abnormal development of veins where they are more tangled and larger then usual.

Do phleboliths need to be treated?

No in most cases.  These are benign and asymptomatic in most cases.  If a patient is having pain in a vein with a phlebolith, sclerotherapy can be considered.  The vein containing the phlebolith will be injected and shrunk.

I had them in the past but the radiologist did not mention this finding on my current exam?

These are so common and benign that some radiologists may not mention this as a finding.  They usually don’t change over time.

Phleboliths summary

Phleboliths are common findings in the pelvis.  They look like small white spots or calcifications. They represent small hardened clots in veins.  They do not pose a danger to health and do not require treatment in most cases.  They can mimic more serious diagnosis in some cases.  This may require further testing with CT.



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