Difficulties in the echographic diagnosis approach of infiltrative bladder tumors

In the echographic examination of the bladder difficulties can appear within the etiological diagnostic of some pathological images.

Aim: Presentation of the echographic particularities of a calcified infiltrative bladder tumoral mass.

Patients and method: We are presenting the case of a patient aged 51 who's describing repeatedly hematuria, weight loss and mictional disturbances since 2 months, on which the echographic investigation shows an arched hyperdense image in the central bladder region, with posterior shade which was initially interpreted as being a bladder stone.

Results: Repeated examination with empty or filled bladder shows the persistence of the hyperdense semicircular band aspect with a significant posterior shade which covers most of the bladder's wall. The rest of the bladder's wall was moderately thickened, which was interpreted as a “fighting“ bladder to overcome the obstacle and also as an additional secondary inflammation. Although the bladder is an easily reachable organ, the particular aspect of infiltrative tumor with intratumoral calcification can create diagnostic confusions with the urinary stones and can be masked by the cumulative calcification shades. The urography could not describe suggestive modifications, the diagnostic certitude being given by the CT, cystoscopy and biopsy.

Conclusions:

1. The primitive, infiltrative, calcified bladder tumor can have a difficult to interpret echographic aspect from a diagnostic point of view.

2. The masking of the tumor as a pseudolitiasic and inflammatory image requires another medical imagery tests for orientation.

3. Echography allows the signaling of important modifications of the bladder, which evaluation require a complex differential diagnostic.