Diagnostic Ultrasound - Abdomen and Pelvis

Bladder Carcinoma
Diagnoses: Urinary Tract
TERMINOLOGY
• Malignant tumor of bladder (95% transitional cell
carcinoma)
IMAGING
• Focal bladder wall thickening with intraluminal extension as
a mass on US, CT, or MR
• Grayscale US: Immobile polypoidal or broad-based mass
along bladder wall, may present as focal wall thickening
• Color Doppler US shows increased vascularity in large
tumors, power Doppler more sensitive in detection of
vascularity in small tumors
○ Useful for bladder tumor screening in patients with
schistosomiasis, tumor within diverticulum
• CTU: better delineation as intraluminal filling defect,
screening upper urinary tract
• MR: T1WI isointense to muscle/bladder wall, T2WI slightly
hyperintense to muscle, early post-gadolinium
enhancement
KEY FACTS
○ High accuracy for locoregional spread, accuracy of
approximately 85% in differentiating nonmuscle invasive
from muscle invasive tumor
• ± enlarged (> 10 mm) metastatic lymph nodes
TOP DIFFERENTIAL DIAGNOSES
• Benign prostatic hypertrophy (BPH)
• Bladder debris &/or blood clot
• Extrinsic tumor/mass
• Bladder inflammation
PATHOLOGY
• Superficial (70-80%) and are usually papillary (70%)
CLINICAL ISSUES
• Painless hematuria, may have hydronephrosis
DIAGNOSTIC CHECKLIST
• Check kidneys, ureters for synchronous and metachronous
tumors
(Left) Graphic shows an
irregular bladder tumor
infiltrating beyond the
muscular layer of the bladder
wall and invading the right
seminal vesicle . There is a
hematogenous metastasis to
the right pubic symphysis .
(Right) Transverse and
longitudinal transabdominal
ultrasound of the bladder
shows a broad-based,
immobile, polypoidal mass
(bladder transitional cell
cancer) ſt.
(Left) Transverse
transabdominal color Doppler
ultrasound of the bladder
shows a solid intraluminal
mass ſt with internal
vascularity consistent with
bladder carcinoma. (Right)
Axial CT urography of the
pelvis in the same patient
confirms the lobulated mass
arises from the left
posterolateral bladder wall.
Margins are well-delineated as
a filling defect in the contrastopacified
bladder. The left
ureter is noted.
534