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Previous Volume 345:1709-1710 December 6, 2001 Number 23 Next

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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 1). 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.

View larger version (83K): [in this window] [in a new window]   Figure 1. A Lithopedion.

 
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

Editor's note: We received 736 responses to this medical mystery. About 72 percent of the respondents said that the abdominal radiograph showed a dead or retained fetus; 196 said it showed a lithopedion or "stone baby," 174 an ectopic or extrauterine pregnancy, 117 a calcified or mummified fetus, 30 a dead fetus, and 10 a retained fetus. Another 18 said the radiograph showed a fetus papyraceus, which is a fetus that has died in utero and been pressed flat against the uterine wall by the growth of a living twin. Other responses included teratoma (44), cecal volvulus (19), current pregnancy (17), dermoid cyst (15), and dentures (11).

References

1. Berman BJ, Katsiyiannis WT. A medical mystery. N Engl J Med 2001;345:1176-1176. [Free Full Text]

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