The left iliac fossa extraperitoneal calcified lesion was projected over the left ilium on the pelvic radiograph giving the appearance of a suspicious left iliac cartilaginous tumor. On further history taking, the patient revealed that she had a previous renal transplant nearly 30 years prior which failed 20 years ago. She is currently on hemodialysis.

Failed renal transplants are often left in situ and may have various appearances on imaging. They may also develop dystrophic calcifications causing diagnostic confusion on radiographs and CT.^1-3

In this patient, peri-implant lucency of greater than 2 mm is concerning of implant loosening and may account for her symptoms of thigh pain.