The AP pelvis image can display a variety of puzzling features which can be usefully separated into

• normal anatomical features
• normal anatomical variants
• artifacts
• foreign bodies

This page should be viewed in conjunction with the closely related page on pelvic calcifications.

The following are a collection of common and not so common examples

Phleboliths are the most common pelvic calcification. Phleboliths tend to have a characterstic distribution, size and shape. They can sometime cause difficulties in patients who present with renal colic. Finding a renal stone poses a challenge in a sea of phleboliths. Philip Shemilt from Salisbury General Hospital noted the following about phleboliths.

1. Gluteal air (linear dark artifact)
2. Mirena intra-uterine device (IUD)
3. transitional features of transverse processes of L5/S1
4. Abdominal fat "apron"

1. Tampon Artifact
2. bra hardware

Discussion

The tampon artifact is very distinctive in shape and position and rarely causes a problem in terms of misidentification. The bra artifacts are the "eyes" from a "hook and eye" bra fastener. Given that the hook part is not visualised, the bra must be undone (which explains why it appears in the pelvis).

Why do the obturator foramen appear asymmetrical? Is this due to fracture, old healed fracture or is the appearance positional?

This patient presented to the Emergency Department following a motorbike accident (motorbike vs kangaroo). The numerous artifacts dispersed across the upper part of the image are almost certainly small stones from the road that were picked up with the patient by the ambulance officers at the accident scene.

Can you see any bony pathology?

1. hip screw
2. calcified fibroid
3. unidentified curvilinear artifact
4. calcification in iliac artery wall
5 ? small geode
6. ECG dot
7. right lamina- ? partial spinabifida occulta
8. surgical staples

Penile implants.

For further information

Richard H. Cohan, N. Reed Dunnick, and Culley C. Carson
Radiology of Penile Postheses
AJR:152, May 1989 pp925 - 931

This is an AP pelvis image on a patient who has presented to the Emergency Department following a motor vehicle accident. The X-ray tube appears to not be centred to the bucky/grid causing grid cut-off artifact. In addition the following artifacts are demonstrated

1 coins
2 wallet
3 zipper
4 jeans stud
5. ?ECG dot ? placement
6. key
7. bucky electronics

The ring opacity is a pessary. Google search "pessary" for more information

the patient has both hands tucked underneath her left hand has several rings (black arrow) patient is wearing sweat pants- the two metal rings are eyelets for the tie cord (vertical white arrow) The underwear elastic is demonstrated (right black arrow) there is a surgical clip - ? vascular surgery (lower grey arrow) the density within the true pelvis is unidentified (white arrow)

	There is a tampon artifact (black arrow) There are artifacts from metal jean studs and a zipper artifact. The arrowed metalic artifacts are probably Filshie clips http://www.kugener.com/museum-sub.php?subkategorie=tubar&show=5 http://www.kugener.com/museum-sub.php?subkategorie=tubar&show=5 Filshie Clip Hulka Clip