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Learning Modules ❯ Genitourinary

Transitional Cell Carcinoma: Non-contrast CT Findings

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

 

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

 

TCC Left Renal Pelvis

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

 

TCC Left Renal Pelvis

  • Pre and postcontrast attenuation of TCC.
TCC Left Renal Pelvis

 

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.
Right Ureter

 

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

 

Upper and Lower Tract TCC

  • Concomitant primary upper and lower tract TCC occurs in 17% of patients.
Upper and Lower Tract TCC

 

Bladder TCC

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

 

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

 

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.
Bladder Diverticulum

 

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.
Calcification in TCC

 

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

 

Pitfall: Collecting System Hematoma

  • Same patient. Findings were suspicious for TCC. Ureteroscopy revealed hematoma
Pitfall: Collecting System 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

 

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.
Pitfall: Collecting System Hematoma

 

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