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919
Gonadal Michael
Vein
E. Berlow,1
Phlebolith
Farhad
Azimi,2
and
Simulating Edward
W.
ratory history
patient
urinary
in whom of the
right
a single
phlebolith
ovarian
vein
was
in the mistaken
suprapelvic
seg-
for a midureteral
Report
Fig. 1 -A, of right
urinary
Anteroposterior tract.
Small
radiograph. round
Received April 1 8, 1 979; ‘ Department of Radiology, Department of Radiology,
2
AJR
133:919-920,
November
calcification,
Round
calcification
phlebolith
accepted after revision Diagnostic Division, St. Joseph’s Hospital
1979
0361 -803X/79/i
department and labo-
in expected
in right
July 6, 1979. State University Health Center,
335-091
ovarian
course vein,
of New York, 301 Prospect
9 $00.00
tract
including a urinalysis were a hysterectomy 20 years
infections
treated
of her abdomen
with
repeated
demonstrated
normal. Her medical earlier and recurrent urethral a small
dilatations. round
calci-
fication in the expected course ofthe right ureter (fig. 1 A). Excretory urography showed this calcification to coincide with the right ureter on all of the radiographs including oblique projections (figs. 1 B and 1 C). There was neither delayed excretion by the right kidney nor pyelocaliectasis. A nonobstructing stone in the right ureter was diagnosed. This calcification remained in the same location on
.
C. B. , a 49-year-old woman, came to the emergency because of sharp right flank pain. Physical examination
findings included
Radiography
stone Case
Stone
Carsky2
Phleboliths most commonly form in the veins of the pelvis and are readily diagnosed as such. This paper presents a ment
a Midureteral
of right ureter.
coincides
Upstate Ave.,
© American
with
right
Medical Syracuse,
Roentgen
Anteroposterior
(B) and right
posterior
oblique
(C) projections
ureter.
Center, 710 E. Adams St., NY 13203. Address reprint
Ray Society
Syracuse, requests
NY 13210. to F. Azimi.
920
CASE
subsequent abdominal radiographs, including one obtained a few hours prior to surgery to remove the right ‘ ‘ ureteral stone.” At surgery the right ureter was found to be normal. The calcification
actually
which
was
Downloaded from www.ajronline.org by 202.4.38.49 on 10/13/15 from IP address 202.4.38.49. Copyright ARRS. For personal use only; all rights reserved
phlebolith
represented
adherent was
the ovarian
a phlebolith
to the
removed
and
vein were
lysed.
anterior the
in the
wall
right
of the
adhesions
ovarian
right
between
vein
ureter.
The
ureter
and
the
AJR:133,
REPORTS
when
a gonadal
laboratory dude urinary tomography
course
of the
quite similar on the right
gonadal
and
the
or occasionally slightly
and
they
may close
have valves and anatomic relation
the tory
longer join
ureter into
are
ureters affecting
veins
on the
the
left
to drain
the left
renal
right side, vein
the
pelvic
into renal
but their
the
inferior
vena
These
veins
course
The
[1 , 2].
[5,
on the
tract stone or retrograde
is sufficient
disease with ureterography
and
can
but clinical
and
cannot
ex-
urography
certainty, computed may help to show the ureter. It is our of cases excretory
establish
the
diagnosis.
noted
gonadal
the English language gonadal vein phleboliths
veins
phleboliths have
not
veins [3]. The and the
excre-
4.
7.
in
of one surgically proven and eight presumed cases in a 3 month period. Our experience with this patient signifies the importance of proper recognition of these phleboliths in an unfamiliar location. These phleboliths can usually be differentiated from midureteral calculi by using the same radiographic
9.
phleboliths and other calcifications this differentiation may be very by the usual radiographic methods be situated in that part of the gonadal of the ureter. In such a rare instance
Human
1 973,
Dykhuizen
RF,
E:
Bobo
Chait
A, Matasar
sions
on the
Mellin
HE,
Derrick
Mackler and
gonodal Kaufman
veins.
Madsen
FC
Fabian
P0:
Jr,
CE,
Right
MH:
obstruction Mellins
AJR
secondary
to
1969
HZ:
Vascular
impres-
1971 by abnormal
right
1975 Lynch
KM
Jr:
Pathological
vein. J Urol
ovarian
vein thrombophlebitis 1968 imprints caused by the left (Stockh) 7 : 21 2-21 8, 1967 varices. AJR 92:340-350,
1 00 : 683-686,
J Uro!
Maxwell
&
Surg
vein syndrome.
and the right ovarian
0, Chidekel N: Ureteric vein. Acta Radio! [Diagn] JJ,
ovarian
of ureter
AR,
ureter HP:
of
Lea
syndrome.
1 02 : 305-307,
6:517-519,
Royster
vein
1 1 1 :729-749,
Rosenblum
arteritis.
ovarian
Obstruction
Urology
in Anatomy
Philadelphia,
1970
ureteral
AJR
of the right 1967 MA,
The
J Urol
KW,
ureters.
vein.
ovarian
1 1 . Bartley
JA:
Bilateral
ovarian
CM,
1
DN: Bilateral
PoIse
and pelvis,
Goss
1 30:443-452, 1971
5,
by
Roberts
113:509-517,
association 97:633-640,
1 2.
edited
GS, Bramwit
Melnick
pp 206-216
of the abdomen
pp 71 0-71
Obstet
spermatic
1 0.
1969,
Body,
enlarged
8.
should the phlebolith vein crossing in front
& Wilkins,
Gynecol 5.
Bartley
H: The veins
Febiger,
The incidence of by our collection
principles in evaluating in the pelvis. However, difficult or impossible
radiologic literature. is not rare, judging
reported
the
6.
in the abdominal been
0, Chidekel N: Right and left gonadal and statistical study. Acta Radio! [Diagn] (Stockh) 4 : 593-601 , 1966 2. Ferris EJ, Hipona FA, Kahn PC, Philipps E, Shapiro JA: Venography of inferior vena cava and its branches. Baltimore, 3. Gray
disorders some of
during
NE,
An anatomical
William
is similar
gonadal
1 . Ahlberg veins.
7, 1 1].
To the best of our knowledge, of the
ureters
is
veins psoas
vein.
are covered by peritoneum between the gonadal veins
impressions
urography
brim
and testicular anterior to the
is the reason for ureteral involvement by these vessels [4-1 0]. This also explains
vascular
segments
above
in both sexes. The ovarian side course cephalad just
muscle
cava
is suspected
as excretory
1979
REFERENCES
Discussion
major
phlebolith
as well
that the calcification is not located within belief, however, that in the vast majority urography
The
vein
data
November
Ureteral
1964 1 3.
Taylor
DA,
Boyes
TD:
Filling
of
following retrograde pyelography: the ureter. Br J Radio! 37 : 625-627,
a varicose
left
a new cause 1964
ovarian
of notching
vein
of