MedPix Medical Image Database

COW - Case of the WeekCase Contributor: Zachary M AlexanderAffiliation: National Naval Medical Center Bethesda

MedPix No: 11063 - HistoryPt Demographics: Age = 36 y.o. Gender = woman36 y.o. woman with gross hematuria

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MedPix No: 11063 - EXAM & LABSUrinalysis: SpGrav 1.018, pH 6.5, Prot >300, Ket neg, Gluc neg, Blood largeSerum Chem: Na 141, K 4.3, Cl 107, CO2 28, BUN 12, Cr 0.9, Gluc 104

Transverse ultrasound of the bladder

Ultrasound images of the bladder demonstrate a lobulated filling defect within the bladder and adherent to the bladder wall.

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Transverse ultrasound of the bladder

Ultrasound images of the bladder demonstrate a lobulated filling defect within the bladder and adherent to the bladder wall.

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Color Doppler ultrasound of the bladder

Doppler ultrasound of the lobulated bladder mass demonstrates significant internal blood flow.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis (yellow) and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter bilaterally. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter bilaterally (arrows). There is extension of the mass through the posterior bladder wall and into the adjacent uterus. Also labeled: ascending colon with feces (open arrow) and psoas muscle (ps).

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Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus.

Downloaded by (-1)

Axial CECT

Axial contrast enhanced CT images demonstrate a lobulated, irregular mass (asterisk *) extending from the posterior bladder wall, with associated hydronephrosis and hydroureter. There is extension of the mass through the posterior bladder wall and into the adjacent uterus (labeled).

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FINDINGSUltrasound of the bladder reveals a lobulated echogenic mass adherent to the bladder wall - with significant internal blood flow on color Doppler. CT images demonstrate a lobulated, irregular mass of the posterior bladder wall with associated hydronephrosis and hydroureter. Additionally, there is tumor extension posteriorly through the bladder wall and into the adjecent uterus.

DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis?Transitional Cell Carcinoma- Squamous Cell Carcinoma- Metastatic disease- Bladder Polyp- Leiomyoma- Fungal Ball- Blood Clot- Debris-

Diagnosis: Transitional Cell Carcinoma, BladderDx Confirmed by: Path Proven Biopsy

DISCUSSIONThis case illustrates the classic findings for transitional cell carcinoma of the bladder. These lesions are commonly discovered due to hematuria. As in this case, ultrasound commonly demonstrates a bladder mass with internal blood flow, and associated obstructive hydronephrosis. These US findings were confirmed on CT imaging.