One of the more common findings we see on pelvic X-rays is small white spots or calcifications. These calcifications commonly arise from pelvic blood vessels but can represent other diagnosis as well.
What are pelvic calcifications?
Pelvic calcifications are deposits of calcium salts which cause a tissue to harden. They appear white on X-ray. Many tissues can calcify in the pelvis. A pelvic calcification does not represent a specific diagnosis.
Pelvic calcification appearance on X-ray
They will appear as white spots of varying size. The location, size, and appearance of the calcification will help narrow the diagnosis.
Pelvic calcifications causes
The most common calcification we see in the pelvis is a phlebolith. Phleboliths are clots in small pelvic veins which calcify over time. They are usually of no consequence.
Arteries in the pelvis can harden and be calcified from atherosclerosis.
Kidney stones which have passed into the ureter can cause pelvic calcifications. The location and patient symptoms can help distinguish them from phleboliths.
Uterine fibroids can be calcified. These are benign growths in the uterus.
Bladder stones can appear as calcifications in the expected location of the bladder. We don’t usually see the bladder on X-rays.
The prostate can develop calcifications which can occur from multiple causes like diabetes, cancer, prior therapy in addition to other causes.
Some tumors can develop calcifications in the pelvis. Ovarian dermoid tumors can develop calcifications. Some cancers can develop calcifications.
The appendix can have a calcification in the lumen which is called an appendicolith. This can cause appendicitis.
Vascular calcifications in the pelvis
This is one of the more common causes. Hardened arteries from atherosclerosis will calcify. This will cause a characteristic appearance of calcifications along the course of a vessel. Some aneurysms of arteries will also calcify.
Veins in the pelvis develop phleboliths. These are calcifications of small clots in the veins of the pelvis.
Calcifications in pelvis symptoms
The symptoms of the calcifications will depend on the cause. Some are without symptoms like phleboliths. Others like passing kidney stones can cause severe pain.
Pelvic calcification treatment
The treatment will depend on the cause. Some will require no treatment like phleboliths. Others like passing kidney stones will require stone removal. Tumors may require surgery, radiation, and chemotherapy.
Small vs large calcifications in the pelvis
Small versus large calcifications help us with the diagnosis. Small calcifications are more likely to represent phleboliths or passing kidney stones. Larger calcifications are more likely to represent fibroids, bladder stones, and tumors.
What further testing can be done?
CT of the pelvis will often be definitive for the diagnosis. We will see exactly where the calcification is arising from. We can also see any tumors associated with calcifications.
Should I be worried about pelvic calcifications?
Usually not as many calcifications are not life threatening. Some tumors can cause pelvic calcifications. The radiologist may suggest further testing when he suspects a tumor, aneurysm or other concerning diagnosis.
Pelvic calcifications summary
Pelvic calcifications have many causes, but the most common is from calcified blood vessels. The appearance, location and size of the calcifications helps us determine their cause. CT is often definitive when we are not sure of the diagnosis or suspect something more concerning.