Phleboliths mistaken for intraperitoneal copper-containing intrauterine device in the presence of missing strings

Although rare, pelvic phleboliths may confound the diagnosis of an intraperitoneal or malpositioned intrauterine device (IUD). Pelvic phleboliths are focal calcifications in pelvic veins, often in multiples near the ureters, occurring in about 40% of adult patients. We treated a 35-year-old woman re...

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Bibliographic Details
Published in:BMJ case reports 2021-03, Vol.14 (3), p.e237838
Main Authors: Nguyen, Viet, Lindley, Alexa R, Mansoori, Bahar, Godfrey, Emily Maria
Format: Article
Language:English
Subjects:
Abdomen
Adult
Birth control
Calcification
Case Report
Case reports
Copper
Family planning
Family Planning Services
Female
Foreign bodies
Gynecology
Humans
Interdisciplinary aspects
Intrauterine Device Expulsion
Intrauterine devices
Intrauterine Devices - adverse effects
Intrauterine Devices, Copper - adverse effects
IUD
Lymphatic system
Pelvis
Primary care
Radiology
Ultrasonic imaging
Ultrasonography
Urology
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Summary:Although rare, pelvic phleboliths may confound the diagnosis of an intraperitoneal or malpositioned intrauterine device (IUD). Pelvic phleboliths are focal calcifications in pelvic veins, often in multiples near the ureters, occurring in about 40% of adult patients. We treated a 35-year-old woman requesting removal of her copper-containing IUD (TCu380A IUD). She had missing IUD strings on clinical examination. A clinic-based transvaginal ultrasound and anteroposterior abdominal radiograph that followed suggested prior TCu380A IUD expulsion. A radiologist later interpreted several ambiguous radiodensities in the abdominal radiograph as a possible intraperitoneal or malpositioned IUD. In collaboration with radiologists and family planning specialists, it was suggested that the patient further undergo a three-dimensional ultrasonography and a CT of the pelvis. The radiodensities first noted on the radiograph were revealed to be phleboliths, a diagnostic possibility not initially considered by any of the primary clinical care team, radiologists or family planning specialists.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-237838