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Phleboliths mistaken for intraperitoneal copper-containing intrauterine device in the presence of missing strings
  1. Viet Nguyen1,
  2. Alexa R Lindley1,
  3. Bahar Mansoori2 and
  4. Emily Maria Godfrey1
  1. 1Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2Radiology, University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Dr Emily Maria Godfrey; godfreye{at}uw.edu

Abstract

Although rare, pelvic phleboliths may confound the diagnosis of an intraperitoneal or malpositioned intrauterine device (IUD). Pelvic phleboliths are focal calcifications in pelvic veins, often in multiples near the ureters, occurring in about 40% of adult patients. We treated a 35-year-old woman requesting removal of her copper-containing IUD (TCu380A IUD). She had missing IUD strings on clinical examination. A clinic-based transvaginal ultrasound and anteroposterior abdominal radiograph that followed suggested prior TCu380A IUD expulsion. A radiologist later interpreted several ambiguous radiodensities in the abdominal radiograph as a possible intraperitoneal or malpositioned IUD. In collaboration with radiologists and family planning specialists, it was suggested that the patient further undergo a three-dimensional ultrasonography and a CT of the pelvis. The radiodensities first noted on the radiograph were revealed to be phleboliths, a diagnostic possibility not initially considered by any of the primary clinical care team, radiologists or family planning specialists.

  • ultrasonography
  • radiology
  • contraception
  • general practice / family medicine

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Footnotes

  • Contributors The patient was under the care of VN and EMG. The report was written by VN, ARL, BM and EMG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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