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Phleboliths

Dr Yuranga Weerakkody and Dr Frank Gaillard et al.

Phleboliths are literally vein stones, and represent calcification within venous structures. They are particularly common in the pelvis where they may mimic ureteric calculi, and are also encountered frequently in venous malformations.

In the former situation, two signs are helpful in distinguishing a ureteric calculus from a phlebolith :

comet-tail sign : favours a phlebolith
soft-tissue rim sign : favours a ureteric calculus

Phleboliths appear as focal calcifications, often with radiolucent centers (another helpful sign if present to distinguish them from ureteric calculi). This appearance is attributed to calcification peripherally within the vessel, and is frequently seen on abdominal radiographs (66% of phleboliths ²). It can also be seen on CT provided thin sections are obtained (at 5mm thick slices radiolucent centers will be inapparent in 99% of phleboliths ²).