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2011-05-19-10 Answer to the case of the week #301 © Mustafaraj

Answer of the case of the week #301

September 1, 2011 - September 15, 2011

Kozeta Mustafaraj, MD., Arben Haxhihyseni, MD., Shuaip Beqiri, MD.

Diagnostic center IKEDA, Tirana, Albania.

Case report

This is a case of a 52-year-old G6 P4 who presented to our gynecology department with a lower abdominal pain and recurrent fever. Patient was postmenopausal and had a long history of a dull pain in the lower abdomen, mostly on the left side. This pain started 14 years ago after spontaneous abortion which occurred in 16 weeks of her pregnancy. Patient was recently loosing some weight and felt tired. 
On the pelvic examination, the uterus was tender on palpation and left parametria showed some retraction. The blood count showed mild anemia.

We performed a transvaginal ultrasound scan and detected a bright echo filling the uterine cavity, there were no other abnormalities detected on our exam. Patient had no history of intrauterine device (IUD).

We decided for hysteroscopic evaluation of the uterine cavity. Hysteroscopy showed a retained long bone inside the uterine cavity which was a remnant of the spontaneous abortion which occurred 14 years ago.
Pathology examination confirmed our diagnosis of lithopedion.

Images 1,2: Image 1 shows the sagittal view of the uterine cavity with an hyperechoic content. Image 2 shows a transverse view of the uterine cavity.


Images 3-8: Hysteroscopy, images show a bone located within the uterine cavity.




Prolonged retention of intrauterine bone has been recognized and described in the literature as a cause of secondary infertility. The retained bones are usually result of a spontaneous or induced abortion in the second trimester.
The most common complaints are secondary infertility, menorrhagia, irregular bleeding, pelvic pain and vaginal discharge. [1] Retained bones act in a manner similar to that of an IUD.
Diagnosis is usually based on the history of abortion and is made by the ultrasound and follow-up hysteroscopy. If retained bones cause infertility, the chance of pregnancy is usually preserved after the removal of the retained bone.
Retained bones can also cause pelvic inflammatory disease or pelvic actinomycosis which is usually characteristic for women using an IUD. [2]


1. Graham O, Cheng LC, Parsons JH. The ultrasound diagnosis of retained fetal bones in West African patients complaining of infertility. BJOG 2000,107(1), pp. 122-124
2. White T, Felix JC. Pelvic actinomycosis with retained intrauterine fetal bone: a case report. J Reprod Med. 2007 Mar;52(3):220-2.


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