ARRS Case of the Week- Jan 28, 2018

GENITOURINARY IMAGING: Collecting System, Ureter, Bladder

Case Author: Rupan Sanyal, MD, University of Alabama at Birmingham

History

58-year-old man with hematuria.

Imaging Findings

Axial unenhanced (A) and contrast-enhanced (B) CT images through the bladder show an enhancing exophytic mass (arrow) involving the left bladder wall. Axial delayed CT image (C) shows the bladder filled with contrast medium. A small contrast-filled outpouching (arrow) anterior to the mass is evident. Coronal delayed phase CT image (D) shows protrusion of the mass (arrows) into the bladder lumen.

Bladder wall pheochromocytoma
Pelvic lymphadenopathy
Urothelial malignancy in bladder diverticulum

Diagnosis

Urothelial malignancy in bladder diverticulum

Teaching Points

Fat necrosis at a lumpectomy site is initially be seen as a spiculated mass or distortion. After these changes contract or resolve, oil cysts and dystrophic calcifications form in some patients. The rate of recurrence of adequately treated breast cancer is less than 2% over 10 years. The development of indeterminate or suspicious calcifications at a lumpectomy site may warrant biopsy to exclude recurrent cancer. However, calcifications related to early fat necrosis can appear indeterminate or suspicious.

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