Diagnostic Ultrasound - Abdomen and Pelvis

Intraluminal Bladder Mass
Differential Diagnoses: Urinary Tract
DIFFERENTIAL DIAGNOSIS
Common
• Bladder Calculi and Sludge
• Blood Clot
• Foley Catheter
• Bladder Carcinoma
• Benign Prostatic Hyperplasia
• Ureterocele
Less Common
• Foreign Body
• Fungal Ball
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
• Confirm mobile vs. immobile intraluminal masses by
scanning in different position (e.g., decubitus)
• Assess for posterior acoustic shadowing seen with stone
and calcified masses
• Assess intralesional vascularity to differentiate tumor from
non-tumor masses
• Enlarged prostate seen as indentation on bladder base
Helpful Clues for Common Diagnoses
• Bladder Calculi and Sludge
○ Bladder calculi seen as mobile, avascular, echogenic mass
with posterior acoustic shadowing
○ Bladder calculi may be present in bladder diverticulum
assessment with optimally distended bladder useful
○ Bladder sludge is sand-like, echogenic, mobile debris
with no posterior shadowing; can be seen associated
with cystitis
○ Sludge balls are mobile, avascular, echogenic mass with
less acoustic shadowing than calculi
• Blood Clot
○ Clinical history of frank hematuria favors diagnosis
– Causes: Spontaneous, post instrumentation, renal
biopsy, or tumor
○ Seen as heterogenous or echogenic, avascular mobile
mass lacking posterior acoustic shadowing
○ May be associated with layering debris (blood-urine level)
• Foley Catheter
○ Round anechoic structure with echogenic rim, often
centrally located
○ Bladder often underdistended/decompressed
• Bladder Carcinoma
○ Often pedunculated polypoidal, rarely broad-based,
frond-like immobile mass with mixed echogenicity
○ Color Doppler shows intralesional vascularity
• Benign Prostatic Hyperplasia
○ Can cause mass-like nodular protrusion of median lobe at
bladder base
○ Difficult to entirely exclude bladder carcinoma on
imaging
• Ureterocele
○ Thin-walled, anechoic/cystic, intravesical mass near
vesicoureteric junction
○ Changes in size based on ureteric peristalsis and
distension
Helpful Clues for Less Common Diagnoses
• Foreign Body
○ Broken Foley catheter, or other foreign bodies;
echogenicity depends on material and may range from
isoechoic to hyperechoic masses ± posterior shadowing
• Fungal Ball
○ Seen in immunosuppressed or diabetic patient
○ Seen as mixed echogenicity, well-defined, mobile,
avascular mass lacking posterior acoustic shadowing
SELECTED REFERENCES
1. Byler TK et al: Incidental computed tomographic bladder wall abnormalities:
harbinger or herring? Urology. 85(2):288-91, 2015
2. Shinagare AB et al: Urinary bladder: normal appearance and mimics of
malignancy at CT urography. Cancer Imaging. 11:100-8, 2011
3. Lieber MM et al: Intravesical prostatic protrusion in men in Olmsted County,
Minnesota. J Urol. 182(6):2819-24, 2009
(Left) Transverse
transabdominal ultrasound
shows a large, echogenic
stone with posterior
acoustic shadowing st within
the urinary bladder. Also note
dependent debris . (Right)
Longitudinal transabdominal
ultrasound through the
bladder shows a Foley
catheter with
underdistended bladder. The
underdistention is often
associated with
pseudothickening of the
bladder wall st.
Bladder Calculi and Sludge
Foley Catheter
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