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Bladder Paraganglioma

60 year old man with metastatic clear cell renal cell carcinoma.

Axial (A) and sagittal (B) images from corticomedullary phase CT reveal a small enhancing mural nodule along the left bladder wall (arrows), presumed to be metastasis. Pathology revealed paraganglioma.

Bladder Paraganglioma

 

Bladder Paraganglioma

65 year old woman with history of hypertension that increased during urination, palpitations and diaphoresis.

Axial arterial phase (A) and delayed phase (B) IV contrast enhanced CT shows a large mass inseparable from the anterior left wall of the bladder. Pathology revealed 4.5 cm paraganglioma involving he muscularis propria and serosal fat.

Bladder Paraganglioma

 

CT Urography: Evaluation of the Bladder

  • Inflammatory disease
  • Bladder neoplasms
  • Trauma

 

CT Cystogram; Technique

  • Foley catheter is placed in the bladder
  • A solution of 500 cc of normal saline is mixed with 30 cc of Iohexol-350
  • Solution is dripped in under gravity to distend the bladder

 

CT of the Bladder

 

Normal CT Cystogram

Normal CT Cystogram

 

CT Urography: Evaluation of the Bladder

  • Inflammatory disease
  • Bladder neoplasms
  • Trauma

 

CT of the Bladder

 

Enterovesicle Fistulae due to Diverticulitis

Enterovesicle Fistulae due to Diverticulitis

 

CT of the Bladder

 

Colovesical Fistula

52 year old man with h/o longstanding diverticulitis and recurrent peridiverticular abscess

Axial venous-phase CECT (A) shows a gas and fluid collection (yellow arrows) adjacent to the bladder, compatible with abscess. Coronal and sagittal (C,D) venous-phase CECT image shows the fistulous connection (red arrows) between the inflamed sigmoid colon and the abscess cavity, an adjacent bladder wall thickening. Patient subsequently underwent open rectosigmoid colectomy.

Colovesical Fistula

 

CT Urography: Evaluation of the Bladder

  • Inflammatory disease
  • Bladder neoplasms
  • Trauma

 

CT Cystogram with Pelvic Fractures

CT Cystogram with Pelvic Fractures

 

CT of the Bladder

 

CT Cystogram with Leak

CT Cystogram with Leak

 

CT of the Bladder

 

CT of the Bladder

 

GSW Pelvis

GSW Pelvis

 

CT of the Bladder

 

CT of the Bladder

 

CT of the Bladder

 

Bladder Perforation s/p Robotic Prostatectomy

Bladder Perforation s/p Robotic Prostatectomy

 

CT of the Bladder

 

CT of the Bladder

 

CT of the Bladder

 

CT of the Bladder

 

Conclusion

  • The key to the CT evaluation of the bladder is to match the clinical question with the optimal protocol
  • Early bladder pathology is a common source of missed diagnosis
  • Careful attention to the rules we discussed should prove valuable in your practice

 

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