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Clinical Images Volume 7 Issue 6
Are they all ureteral stones doctor?
Mohammed Alae Touzani,1,2 
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Souhail Regragu,1,2 Amine Slaoui,1,2 Tariq Karmouni,1,2 Khalid El Khader,1,2 Abdellatif Koutani,1,2 Ahmed Ibn Attya Andaloussi1,2
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1Faculty of Medicine and Pharmacy, Mohammed 5 University, Morocco
2Urology Department, Ibn Sina Teaching Hospital, Morocco
Correspondence: Mohammed Alae Touzani, Faculty of Medicine and Pharmacy, Mohammed 5 University, Rabat, Morocco, Tel 0661318983
Received: September 24, 2019 | Published: November 6, 2019
Citation: Touzani MA, Regragui S, Slaoui A, et al. Are they all ureteral stones doctor? Urol Nephrol Open Access J.2019;7(6):131. DOI: 10.15406/unoaj.2019.07.00259
Clinical Image
Phleboliths are defined by the presence of calcification at the wall or the lumen of a vein. They are often secondary to venous valve abnormalities. They are most often found in veins of the pelvis (periureteral, periprostatic or perivaginal plexi). Thus, it can sometimes be difficult to differentiate them from lower ureter stones.
We report the case of Mr. T.O., 56 years old, with no previous medical history, who has been consulting for an abdominal and right low back pain for one week with no digestive sign. A KUB (kidney, ureter and bladder) X-ray showed multiples round calcic images (more than 30) on the pelvic area (Figure 1). An abdomino-pelvic CT-scan showed a 9 mm and 1000 HU pelvic ureteral stone with ipsilateral uretero-hydronephrosis. Extracorporeal shock wave lithotripsy (ESWL), which is indicated, could not be done because of the presence of multiples calcic images, which make the fluoroscopic identification difficult. We put the patient under medical expulsive therapy. The patient expulsed the stone after 22 days.
Figure 1 KUB x-ray showing multiples pelvic phleboliths.
On KUB x-ray, differentiate between phleboliths and ureteral stone is tricky. However, cockade-like with central lucency perfectly round calcic images are more likely to be phleboliths. Enhanced CT scan is the gold standard to differentiate between stone or phleboliths. It can show direct signs of ureteral obstruction. To avoid the contrast agent injection, an unenhanced CT scan can be performed. Three parameters can help in diagnosis: the rim sign if there is a ureteral obstruction (peri-ureteral oedema), the comet sign (the non-calcified vein portion in continuity with the calcification) and the density of the calcification (if inferior to 300 UH, it is more likely to be a phlebolith).
Acknowledgements
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Funding details
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Conflicts of interest
The author declares there is no conflict of interest.
©2019 Touzani, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.