Genitourinary - Learning Modules - CTisus.com CT Scanning

Transitional Cell Carcinoma: Non-contrast CT Findings

Elliot K. Fishman, M.D.

The Russell H. Morgan Department of Radiology and Radiological Science
The Johns Hopkins Medical Institutions
Baltimore, Maryland

TCC Left Renal Pelvis

67 year old woman with left renal pelvis TCC
On a noncontrast CT, renal collecting system should be fluid density. This provides a background against which soft tissue density masses in collecting system can be visualized.
The wall of the renal pelvis and ureter should be barely perceptible.
Coronal MPRs facilitate identification of abnormal soft tissue in the upper track collecting system and the bladder.

TCC Left Renal Pelvis

55 year old man with soft tissue mass in the left renal pelvis and wall thickening (arrows) are seen on noncontrast images.

TCC Left Renal Pelvis

79 year old man with TCC in the left renal pelvis seen on noncontrast images.

TCC Left Renal Pelvis

Pre and postcontrast attenuation of TCC.

Right Ureter

78 year old woman with right ureteral mass measuring 41 HU (arrows) on the precontrast images (A,B), although better visualized on the arterial phase coronal MPR (C) . Normal ureter should have barely perceptible wall and fluid density in the lumen.

Upper and Lower Tract TCC

69 year old man with TCC of the right renal pelvis and bladder. Note soft tissue density in the right renal pelvis on the precontrast scan.

Upper and Lower Tract TCC

Concomitant primary upper and lower tract TCC occurs in 17% of patients.

Bladder TCC

83 year old man with TCC, conspicuity optimized by high contrast window.

Bladder

61 year old woman with bladder mass. Tumor conspicuity improved by use of high contrast display with both axial images and coronal MPR.

Bladder Diverticulum

76 year old man with TCC in large left bladder diverticulum. Because diverticulum does not fill with contrast on delayed phase but urine density slightly increases, the TCC conspicuity is better on precontrast than delayed, but best on arterial phase.

Calcification in TCC

Calcification is present in 2% of renal TCC and 0.7 – 6% of bladder TCC on CT and can be seen on noncontrast imaging.

Pitfall: Collecting System Hematoma

37 year old woman with SLE and soft tissue mass in upper pole calyces seen on noncontrast CT.

Pitfall: Collecting System Hematoma

Same patient. Findings were suspicious for TCC. Ureteroscopy revealed hematoma

Pitfall: Collecting System Hematoma

66 year old woman with large left kidney renal cell carcinoma that hemorrhage into ureter and bladder (arrows). Hemorrhage can mimic TCC in density, but would stay same attenuation on pre and post contrast acquisitions and resolves over time.

Pitfall: Collecting System Hematoma

66 year old woman with large left kidney renal cell carcinoma that hemorrhaged into ureter and bladder. Follow up imaging shows resolution of hemorrhage in bladder.

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