Phleboliths: Understanding Calcification in Veins and Pelvis
Medically reviewed by Josephine Hessert, DO
Phleboliths (vein stones) are calcified blood clots that form inside veins. They typically occur in areas where blood flow is slower and more prone to clotting, such as the pelvis—minerals like calcium coat old blood clots or fragments of them to form these rounded lumps.
This article will explore how and where phleboliths form, what they feel like, and when—or if—treatment is needed.
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Read Next: What Are Bladder Stones (Calculi)?
Definition of Phleboliths
A phlebolith is a small, round calcification that can form in blood vessels. These layers of calcium and fibrous tissue coat old blood clots and may be more common in the veins of the pelvis. Increased abdominal pressure from bowel and bladder straining may contribute to the formation of blood clots and, eventually, phleboliths.
Formation
Little research has been published on phleboliths since they were first described in the 1920s. Although these calcified blood clots were suspected in some patients, the widespread use of X-ray technology helped uncover the origins of these calcifications.
Phleboliths typically form in passive blood vessels where blood pooling and stasis (lack of movement) can occur due to minimal surrounding muscle support. They are sometimes associated with hemangiomas (benign vascular tumors) or varicose veins and may be confused with urinary stones.
Most phleboliths are formed from a buildup of calcium carbonate or calcium phosphate salts over blood clots that are never fully resolved or cleared from your blood vessel.
Affected Body Parts
Phleboliths usually form in areas where blood can collect or pool due to a lack of movement, slow circulation, and limited muscle support. This can happen anywhere where a blood clot forms, but phleboliths are typically found in the following areas:
Mouth and cheeks
Jaw and parotid glands
Tongue
Pelvic Phleboliths on X-Ray
Diagnosis of phleboliths was made easier by the availability of X-ray imaging. While X-rays can still spot phleboliths, computed tomography (CT) scanning is the preferred method since it can help healthcare providers identify the difference between a phlebolith and other types of stones and calcifications.
Appearance
On an X-ray, calcifications like phleboliths appear circular and measure around 3–7 three to seven millimeters (mm). A phlebolith's shape will look different from a urinary or kidney stone. Instead of being round or oval-shaped, phleboliths often have a rim around the outer edges of the calcification and a tail known as the "comet sign."
Detailed imaging can help provide more information. Phleboliths and urinary or kidney stones are differentiated based on anatomical location on a CT scan.
Phleboliths vs. Kidney Stones Diagnosis
Even with detailed imaging, spotting the difference between a phlebolith and other types of stones that may form in the pelvis can be difficult. Computer software and newer artificial intelligence technology can be used to help analyze images and make a more precise diagnosis.
Related: What Are Kidney Stones?
Typical Phlebolith Symptoms
The majority of phlebolith cases are asymptomatic. People who do report symptoms that can be attributed to phlebolith formation describe things like:
Aching or soreness in the pelvis
Flank pain (on the sides of your body between your ribs and hips)
Abdominal pain
Lower back pain
Learn More: Pelvic Pain in Women and Men
Are Phleboliths Something to Worry About?
Phleboliths occur in roughly 40% of adults and are more common in people over 40. Most people have never known these calcifications exist. Typically, they are identified as a secondary finding on imaging. If symptoms do occur, they are usually mild and don't require treatment.
Treating Severe Pain from Phleboliths
What kind of pain and the severity of that pain will depend on where your phlebolith develops and whether it causes inflammation and swelling in the vessel and surrounding tissues.
Warm compresses and over-the-counter pain or anti-inflammatory medications can help moderate pain and swelling. More significant pain or swelling may prompt surgical removal of the phlebolith, but in most cases, they are left in place and observed for changes over time.
Summary
Phleboliths are calcified blood clots that typically form in the pelvis but may also be found in the head and neck. Most people don't experience symptoms from these growths, but soreness and abdominal pain may occur.
Phleboliths are usually found inadvertently on imaging tests for other reasons and may be confused with kidney or ureteral stones. In most cases, phleboliths are observed, but no surgical removal or invasive treatment is required.
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