Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Radiology, University of Washington School of Medicine, Seattle, Washington, USA.
BMJ Case Rep. 2021 Mar 22;14(3):e237838. doi: 10.1136/bcr-2020-237838.
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.
虽然罕见，但盆腔静脉血栓可能会混淆腹腔内或子宫内节育器（IUD）位置不当的诊断。盆腔静脉血栓是盆腔静脉中的局灶性钙化，常多发于输尿管附近，约见于 40%的成年患者。我们治疗了一位 35 岁的女性，她要求取出含铜宫内节育器（TCu380A IUD）。临床检查时发现她的 IUD 线不见了。随后进行的基于诊所的经阴道超声和前后位腹部 X 线片提示先前 TCu380A IUD 已排出。放射科医生后来在腹部 X 线片上解释了几个模糊的放射密度，认为可能是腹腔内或位置不当的 IUD。在放射科医生和计划生育专家的协作下，建议患者进一步进行三维超声和盆腔 CT 检查。放射科医生最初在 X 光片上发现的放射密度被证实为静脉石，这是临床护理团队、放射科医生或计划生育专家最初都没有考虑到的诊断可能性。
