Look at the bladder, please- Pictorial essay of bladder findings on computed tomography
Number:27ESURABS0038
Type:Scientific Electronic Presentation
Authors: Margarida Lima, Carolina Tim-Tim, Mónica Coutinho, João Pedro Caldeira
Keywords:computed tomography, urinary tract, bladder, diagnostic imaging, bladder cancer, fistulae, infectious, inflammatory, diverticulum
SECTIONS
Objectives

Localized in the lesser pelvis, the urinary bladder is an extraperitoneal structure. Its wall is formed by 4 layers: uroepithelium, lamina propria, muscularis propria and adventitia, with a thickness that does not exceed 5 mm when distended. (1). 

A wide variety of disorders manifest as a focal mass or diffuse bladder wall thickening (of its different portions) either of neoplastic or non-neoplastic origins, such as inflammatory, idiopathic, infections and congenital anomalies. (2)

Since its introduction in medical practice, in 1973, Computed tomography (CT) imaging) has become increasingly valuable in the study of the urinary tract (and can be used)in two (different modes) modalities:  computed...

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Material and methods

Pictorial essay, based on 36 CT images obtained retrospectively from Picture Archiving and Communication System (PACS) workstation of an oncological specialized tertiary referral center . The authors selected 10 images that illustrate pathology of different etiology to be included on the scientific poster. A complete image and report review of each examination was made.

All CT images were retrospectively and independently reviewed by two radiologists. 

Images  presented as malignancy had histopathology reports confirming the diagnose.


Results

Besides acute trauma settings and haematuria study, bladder imaging on CT has been largely ignored, particularly when it comes to malignancy diagnosis. Urothelial carcinoma represents 90% of bladder tumors. Trinh et al studied the use of CTU for the diagnose of bladder cancer in patients with haematuria and those under surveillance, concluding that it was 92% % (650/710) accurate but its sensitivity was only 86%, making cystoscopy not possible to obviate, in our days. Non papillary tumours, that manifest as flat masses or erythematous lesions, like Carcinoma in Situ (CIS) may be one cause for this low sensitivity. In the other hand, some patients that are high risk for bladder cancer are sometimes examined by cystoscopy, without undergoing a CT. Besides late excretory phase (EP) imaging analyzing, urothelial phase (UP)  with...

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Figure 1- Axial non contrast-enhanced CT showing intraluminal gas causing an air/fluid level in the bladder, as well as intraparietal gas dissecting through its posterior wall. Emphysematous cystitis in 84 year old female patient with MSSA bacteremia .
Figure 2- Axial contrast-enhanced CT, late excretory phase. There are two large outpouchings of the bladder wall that fill in with contrast in the late excretory phase. Bladder diverticula.

Conclusions

Bladder imaging on CT is sometimes disregarded. This pictorial essay proves its usefulness providing information about morphology, congenital or acquired anomalies, position, infectious and inflammatory diseases, traumatic injuries, neoplasia and bladder cancer mimics. It broads the spectrum of bladder imaging radiologist should look for on CT, regardless of its indication.

 

Bibliography

 

  1. Webb, W. R., Brant, W. E., & Major, N. M. (2006). Fundamentals of body CT. Philadelphia: Elsevier/Saunders.2
  2. Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ. From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radiographics. 2006;26(6):1847-68)
  3. Salmanoglu E, Halpern E, Trabulsi EJ, Kim S, Thakur ML. A glance at imaging bladder cancer. Clin...

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