Genitourinary - Learning Modules - CTisus.com CT Scanning

MDCT of the Bladder: Interesting Cases

Elliot K. Fishman, M.D.

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

Bladder Cancer: Facts

Estimates of 72,570 new cases and 15,210 deaths in the US in 2013
Most cancers are transitional cell carcinoma while others are squamous cell carcinoma and adenocarcinoma
Data from NCI (National Cancer Institute)

Bladder Cancer

“The presence of a discrete bladder mass or nodule should be considered suspicious for malignancy . In many cases, such lesions may be better appreciated on early phase images when surrounded by low-attenuation urine, particularly when the lesion is avidly enhancing, although a discrete filling defect may not be difficult to appreciate on delayed images when the nodule is large.”
Bladder Malignancies on CT: The Underrated Role of CT in Diagnosis
Raman SP, Fishman EK
AJR 2014; 203:347–354

Bladder Cancer-Subtle Enhancement

Bladder Cancer in Patient with hematuria

Transitional Cell Carcinoma

Multifocal TCC

Incidental Bladder Tumor

Bladder Cancer in a Diverticulum

TCC in Bladder Diverticulum

Urachal Carcinoma

Pheochromocytoma in Organ of Zuckerkandl

Bladder Pheochromocytoma

Extraadrenal Paragangliomas: CT Findings

Homogeneous or heterogeneous hyperenhancing mass
Range in size from 1 cm to over 20 cm
Common locations are carotid body, jugular foramen, aorticopulmonary region, posterior mediastinum, abdominal paraaortic region including Organ of Zuckerkandl, and pelvis

Bladder Paraganglioma

SECONDARY MALIGNANCIES: Metastatic Disease

Metastatic Prostate Cancer to the Bladder

Bladder Lymphoma

BENIGN MIMICS OF TUMOR: Bladder Hematoma

Malakoplakia

Cystitis Cystica

chronic reactive inflammatory disorder, which occurs in the setting of chronic irritation.
cystoscopy typically yields a "cobblestone appearance" of mucosa.
as opposed to urothelial carcinoma, cystitis cystica will not invade the muscularis layer of the bladder
treatment: removal of inciting irritant (infectious, obstructive, etc)
Follow up imaging prudent due to possible association with adenocarcinoma

Mullerianosis

Colovesical Fistula

Herniating Bladder

INFECTIOUS PROCESSES: BK Cystitis

Polyomavirus BK cystitis:

bladder wall thickening
urine attenuation may be increased in patients with hemorrhagic cystitis.
minority have intraluminal clots.
perivesical stranding uncommon

Emphysematous Cystitis

Schistosomiasis