People often wonder what phleboliths are after seeing references to them in radiology reports, and for good reason. The name is a bit misleading because phleboliths, which are primarily found in the pelvis, are actually small, rounded calcifications found in veins. Although the name may raise concern, phleboliths are generally completely benign and are discovered incidentally. Regardless of their benign nature, they are important to explain because of the need for good health and peace of mind.
This article seeks to demystify phleboliths through reviewing their etiology, symptomatology, and management.
What are phleboliths?
Phleboliths, which can occur anywhere in the body, are calcified obstruction of venous blood clot streams in the body. Although phleboliths can occur anywhere in the body, they are primarily found in the pelvis, which are where the majority of veins are located. They are venous obstructions that primarily occur due to minor blood clots that form and remain stagnant in a vein to be slowly calcified with calcium.
Phleboliths are characterized by a rounded pebble like calcified inflammation of veins, are generally in the range of 2-5 mm in size, are typically seen in older adults over 40 with no underlying health issues, and phleboliths are generally noticed by accident during radiology such as X-rays and CT scans. Most phleboliths are entirely benign, hence their minimal clinical relevance. However, such phleboliths can also be associated with underlying problems, with the veins of the body being the most pertinent.
What Causes Phleboliths?
There are multiple derived causes of why phleboliths form, but the primary cause is venous blood stasis, where blood flow decreases or even becomes stagnant. Blood can create small clots within a vein, and these clots can develop calcification over time.
1. Chronic Venous Insufficiency
When blood has difficulty being sent back to the heart, the lower body can end up having blood pooling within it. This increases the likelihood of phleboliths and the corresponding blood clots.
2. Varicose Veins
People who have varicose veins are more likely to develop phleboliths, as varicose veins are a type of weak, swollen, and stagnant veins.
3. Pelvic Congestion Syndrome
Primarily affecting women, this syndrome encompasses the enlargement of the pelvic veins, which increases the likelihood of blood clots that can lead to phleboliths.
4. Local Inflammation
Inflammation of the surrounding tissues and/or veins can promote the formation of blood clots, which can eventually lead to calcified clots.
5. Age-Related Changes
Due to the natural aging process, the blood vessels lose elasticity and can be more susceptible to blood clots, which is a likely reason for the correlation between phleboliths and the aging population.
6. Sedentary Lifestyle
A lack of movement or prolonged sitting can lead to phleboliths due to blood pooling in the pelvic region.
7. Pregnancy
Although pregnancy is an important part of life, the pelvic pressure veins tend to increase, contributing to the possibility of blood clotting and calcification.
Phleboliths can form without any specific reasons and are typically normal signs of aging.
Common Symptoms of Phleboliths
Phleboliths are mostly asymptomatic, and people notice the condition mainly through an image.
A few symptoms can occur, such as:
1. Pelvic Pain
Certain people may feel some level of chronic pelvic pain.
2. Lower Abdominal Pain
If large plheboliths are present, they can lead to abdominal pain if they irritate some of the adjacent lesser tissues.
3. Venous Issues
Out of all symptoms, phlebolith are most commonly associated with varicose veins, and other venous insufficiencies. These can lead to heavy and swollen legs and may result in visible veins.
4. Pain During Movement
Rarely, someone may experience pain when compressing the pelvic veins.
5. Confusion with Kidney Stones
Phleboliths can be confused with kidney stones, especially when there is flank pain. This can occur even if there are no kidney problems present.
Important Note:
Phleboliths never cause urinary symptoms, nausea, fever, or blood in urine. If those symptoms are present, another issue likely is the cause.
How are Phleboliths Diagnosed?
Phleboliths are most commonly found incidentally when using diagnostic imaging for another health concern.
Standard imaging includes the following:
1. X-ray
These show up as small, white, round spots with a lucent center which helps radiologists differentiate the spots.
2. CT Scan
CT scans are more detailed than X-ray and are able to differentiate phleboliths from other structures such as kidney stones or other calcifications.
3. Ultrasound
Ultrasound is infrequently used for phleboliths but could shed light on other venous conditions.
Radiologists can easily differentiate phleboliths from serious issues. It is often a straightforward diagnosis because of the phleboliths unusual shape and their position.
Are Phleboliths Dangelous?
Generally, phleboliths are harmless and do not need treatment. They do not break off like dangerous blood clots. They also do not occlude major blood flow. If, however, phleboliths are a result of other venous issues, those problems may need to be addressed.
Treatment for Phleboliths
1. No treatment.
This is the most common and the most likely treatment. Phleboliths are harmless and thus the most common approach is no treatment. It is considered benign and part of the normal aging process of many.
2. Treat Underlying Venous Issues
Your phleboliths might be a consequence of problems with the veins, specifically, varicose veins, pelvic congestion, or venous insufficiency. In treating the following conditions, the following may help issues with underlying veins:
– Leg elevation
– Compression stockings
– Exercise to improve circulation
– Avoid long sitting periods
– Weight management
3. Management of the pain
It’s very rare to have pain from phleboliths, but when it occurs, doctors sometimes suggest the following:
– NSAIDs, like ibuprofen or naproxen
– Lifestyle changes
– Warm compresses
4. Infrequent venous procedures
In the case of some serious venous issues, the following are possible treatments:
– Sclerotherapy
– Phlebectomy
– Endovenous ablation
– Embolization of pelvic veins (for pelvic congestion syndrome)
5. In case of doubt
Another opportunity to rule out other causes of calcification could be a follow-up CT scan.
Preventing phleboliths
You could improve the overall health of your veins and thereby lower the risk of phleboliths. Not always possible, but a few things may help.
– Avoid prolonged sitting and remain active
– Stay hydrated
– Avoid smoking
– Maintain a good weight
– If you have varicose veins, wearing compression stockings can help.
FAQs based on phleboliths
1. Are phleboliths dangerous?
Phleboliths are not dangerous, and you don’t need treatment unless they are related to another venous problem.
2. Do phleboliths cause pain?
In general, phleboliths themselves do not cause pain. If there is pain occurring, it may be from irritation of nearby tissues or veins, but phleboliths themselves do not cause pain.
3. Are phleboliths the same as kidney stones?
No. They are commonly misdiagnosed as kidney stones on images, but are completely different, occurring in veins as opposed to within the kidneys.
4. Can phleboliths go away on their own?
No. After they are formed and calcified, they tend to linger, but they are not problematic.
5. How are phleboliths diagnosed?
These are generally diagnosed via an X ray or a CT scan, where they can be seen as small, round, hardened structures.
6. Do phleboliths require surgery?
Almost never. Surgery can be done, but this is only an option if there are serious venous and symptomatic issues.
7. Can phleboliths cause urinary symptoms?
No. Phleboliths do not have any effect on the urinary system or the kidneys.
8. What age group is most affected?
Adults over 40 are the most likely to have phleboliths as these are a consequence of the venous system changes that occur with age.
