Luk Angus Chin On, Cleaveland Paul, Olson Louise, Neilson Donald, Srirangam Shalom Justus
Department of Urology, Royal Blackburn Hospital , Blackburn, United Kingdom .
J Endourol. 2017 Apr;31(4):342-347. doi: 10.1089/end.2016.0861. Epub 2017 Feb 17.
Pelvic phleboliths are commonly encountered on plain and CT imaging and remain a source of frustration when attempting to differentiate them from ureteral calculi. Given their frequency, surprising little is known about their significance. We review the literature on pelvic phleboliths, specifically in relation to their history, demography, clinical significance, and methods to distinguish them from ureteral calculi.
A comprehensive literature search was performed for all articles concerning pelvic phleboliths.
Pelvic phleboliths were first described in 19th century when the presence of calcified intravenous nodules was observed in human dissection. With the discovery of X-ray imaging in 1895, they have caused much diagnostic controversies since. Histologically they are composed of calcified laminated fibrous tissue, with a surface layer continuous with vein endothelium. Prevalence of pelvic phleboliths in adults is reported to be 38.9%-48%. They are more common in adults aged over 40, and appear to equally affect both genders. They may be associated with diverticulitis, vascular abnormalities, and are more commonly seen in individuals from economically developed countries. The soft-tissue "rim"sign (50%-77% sensitivity and 92%-100% specificity) and a geometric shape (100% positive predictive value [PPV]) are radiological signs predictive of ureteral calculi on unenhanced CT scanning. Radiological signs suggestive of phleboliths include the presence of central lucency (8%-60% sensitivity and 100% specificity), rounded shape (91% PPV), and the comet-tail sign (21%-65% sensitivity and 100% specificity). Phleboliths appear to have a significantly lower Hounsfield unit enhancement than ureteral calculi (160-350 HU).
Pelvic phleboliths are a common radiological finding, especially in the older population, which continue to present diagnostic challenges in those with suspected ureteral calculi. With greater awareness, the uncertainty can be overcome by identifying defining characteristics when interpreting radiological investigations.
盆腔静脉石在X线平片和CT成像中很常见，在试图将它们与输尿管结石区分开来时，仍然是一个令人困扰的问题。鉴于其出现频率，人们对其意义却知之甚少。我们回顾了关于盆腔静脉石的文献，特别是关于它们的历史、人口统计学、临床意义以及将它们与输尿管结石区分开来的方法。
对所有关于盆腔静脉石的文章进行了全面的文献检索。
盆腔静脉石于19世纪首次被描述，当时在人体解剖中观察到钙化的静脉结节。自1895年X线成像技术被发现以来，它们一直引发诸多诊断争议。从组织学上看，它们由钙化的层状纤维组织组成，表面层与静脉内皮连续。据报道，成年人盆腔静脉石的患病率为38.9% - 48%。它们在40岁以上的成年人中更为常见，并且似乎对男女的影响相同。它们可能与憩室炎、血管异常有关，在经济发达国家的人群中更常见。软组织“边缘”征（敏感性为50% - 77%，特异性为92% - 100%）和几何形状（阳性预测值[PPV]为100%）是在未增强CT扫描中预测输尿管结石的放射学征象。提示静脉石的放射学征象包括中央透亮（敏感性为8% - 60%，特异性为100%）、圆形（PPV为91%）和彗星尾征（敏感性为21% - 65%，特异性为100%）。静脉石的亨氏单位强化似乎明显低于输尿管结石（160 - 350 HU）。
盆腔静脉石是一种常见的放射学表现，尤其是在老年人群中，对于疑似输尿管结石的患者，它们仍然带来诊断挑战。随着认识的提高，在解读放射学检查结果时，通过识别其特征可以克服这种不确定性。
