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Distended Bladder

 9/18/2011  - This week's Image of the Week is brought to us Dr. George Leach. While evaluating a 59 yo M with hematuria and abdominal pain, Dr. Leach performed a bedside US showing the following bladder images – see images #1 & #2. These images show a significant abnormality in the bladder requiring prompt consultation and management.

bladder transverse

iow sagittal bladder

Probe placement for bladder imaging is shown in the attached images, #3 (transverse) & #4 (sagittal). Using the curvilinear probe, the transverse view is obtained with the probe indicator to the right of the patient. The sagittal view is obtained by rotating the probe 90 degrees - the indicator now toward the head of the patient. From both positions, subtle fanning movements permits full visualization of the fluid filled bladder.

bladder transverse

bladder sagittal

Looking back at images #1 & #2, the critical finding is a distended bladder with a large clot of mixed echogenicity – likely representing acute and subacute bladder hemorrhage. With a history of colorectal cancer, these US findings suggest recurrent disease and likely metastatic spread to the bladder. Bladder irrigation was promptly started in the ER and Urology consultation was made. The patient was also found to be anemic, hyperkalemic, and with acute kidney injury secondary to his urinary obstruction. Disease recurrence with metastatic spread was confirmed on admission CT scan.