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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