Correspondence

Medical Mystery — The Answer

N Engl J Med 2001; 345:1709-1710December 6, 2001

Article

The medical mystery in the October 18 issue1 involved a 78-year-old woman with hypertension and diabetes who was hospitalized with cellulitis of her left lower leg. Colicky right-flank pain associated with nausea and vomiting developed. Intravenous urography showed no evidence of calculi or ureteral obstruction. However, a lithopedion in the right lower quadrant of the abdomen was noted (Figure 1Figure 1A Lithopedion.). The woman said she had had three pregnancies, all of which had resulted in term deliveries. Her menses had ceased at approximately 45 years of age. She had no history of abnormal vaginal bleeding, amenorrhea, or abdominal pain.

Lithopedion is derived from the Greek words lithos, meaning stone, and paidion, meaning child. It describes an extrauterine fetus that has become calcified. This rare event, estimated to occur in 1 of every 700,000 pregnancies, requires the presence of a medically undetected extrauterine pregnancy with continued asepsis of the products of conception. A fetus that dies within the first three months of pregnancy will be absorbed; survival of the fetus for more than three months results in a nidus for calcification and lithopedion formation.

Our patient's symptoms resolved spontaneously. Although a fetus retained in the abdomen can be removed surgically, the patient's age and coexisting conditions precluded such an operation.

Brett J. Berman, M.D.
William T. Katsiyiannis, M.D.
Washington University School of Medicine, St. Louis, MO 63110-1093

1 References

1. 1

   Berman BJ, Katsiyiannis WT. A medical mystery. N Engl J Med 2001;345:1176-1176
   Full Text | Web of Science