An unusual cause of intra-abdominal calcification: A lithopedion

Abstract

We report a case of a 77-year-old female who was admitted to the emergency department complaining of diffuse abdominal pain for five days, associated with nausea, vomiting and constipation.Physical examination disclosed a large incarcerated umbilical hernia, which was readily apparent on supine abdominal plain films. These also showed a calcified heterogeneous mass in the mid-abdominal region, which was further characterized by CT as a lithopedion (calcified ectopic pregnancy). This is one of the few cases studied on a MDCT equipment, and it clearly enhances the post-processing abilities of this imaging method which allows diagnostic high-quality MIP images.Lithopedion is a rare entity, with less than 300 cases previously described in the medical literature. However, many reported cases corresponded to cases of skeletonization or collections of fetal bone fragments discovered encysted in the pelvic region at surgery or autopsy. It is thus estimated that true lithopedion is a much rarer entity.The diagnosis may be reached by a suggestive clinical history and a palpable mass on physical examination, while the value of modern cross-sectional techniques is still virtually unknown. Ultrasonography may depict an empty uterine cavity and a calcified abdominal mass of non-specific characteristics, and computed tomography or magnetic resonance imaging are able to reach a conclusive diagnosis and may additionally define the involvement of adjacent structures.The differential diagnosis includes other calcified pathologic situations, including ovarian tumors, uterine fibroids, urinary tract neoplasms, inflammatory masses or epiploic calcifications.

Lithopedion as a factor in post‐traumatic intestinal perforation

“…Married for 35 years and considered nulligravida by her husband, the pregnancy that led to the formation of the lithopedion was unknown to the patient. This has also reported [3]. Other cases involved multiparous patients [4,6].…”

Grossesse abdominale momifiée

“…Dans cette pathologie, la radiologie est d'un grand apport. Si l'échographie ne fait que diagnostiquer un utérus vide et la présence d'une masse latéro utérine calcifiée, le scanner et surtout l'IRM permettent de faire le diagnostic [ 2 , 4 , 6 ]. Cependant, d'autres diagnostics doivent être éliminés en particuliers les tumeurs ovariennes calcifiées.…”

An unusual cause of renal colic: ovarian teratoma

“…Ovarian cancer is described as the most common cause of malignant extrinsic ureteral obstruction (16.6%) ( 3 ), but the exact prevalence of ureteral involvement by ovarian MCT is still unknown. The differential diagnosis of calcifications in abdominal plain films of the female pelvis include: vascular calcifications (atherosclerosis, calcified aneurysms, phleboliths), those originating from the urinary tract (ureterolithiasis and vesical lithiasis), inflammatory masses (epiploic calcifications, dropped gallstones, foreign bodies) and nodal calcifications ( 4 ).…”