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Hello Doctor: I am 37, male with a history of

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Posted on Sat, 9 Mar 2019
Question: Hello Doctor:
I am 37, male with a history of smoking. I had blood in my urine 4 months ago and it went away by itself. I saw it again around one month ago and the urologist checked my urine and ordered CAT SCAN. Below is the report of CAT SCAN. I am scheduled for to do cystoscopy in mid-march. I am wondering if the CT report is very concerning? If it is concerning do you think my urologist should do the cystoscopy earlier? I much appreciate any suggestions and recommendations.
**URGENT UNEXPECTED FINDING**

CT abdomen and pelvis without and with contrast 02/12/2019:

HISTORY: Hematuria.

TECHNIQUE: Helically acquired axial images were obtained through the abdomen and pelvis both before and after the injection of 100 mL Omnipaque 300 intravenous contrast and supplemented with sagittal and coronal reconstructed images. Automated dose control was utilized

COMPARISON: None.

FINDINGS: There are no urinary tract stones or hydronephrosis. The kidneys demonstrate normal symmetric enhancement and there are no solid renal masses on either side. Delayed phase images demonstrate appropriate excretion of contrast into the collecting system and renal pelvis on each side and no filling defects are evident. Only the proximal half of each ureter is opacified but the ureters are normal caliber without appreciable abnormality. There is a polypoid enhancing mass along the posterior wall of the urinary bladder on the left measuring approximately 18 x 12 mm in transaxial dimensions and 13 mm in CC length. This is most concerning for a urothelial lesion such as transitional cell carcinoma.

The remaining solid organs have a normal contrast-enhanced appearance and are free of acute abnormalities. The gallbladder is unremarkable. The bowel is nonobstructed. The appendix is normal caliber. There is no free air, free fluid or focal inflammatory changes and there is no adenopathy in the abdomen or pelvis.

IMPRESSION:
Enhancing polypoid mass along the posterior wall of the urinary bladder on the left concerning for urothelial malignancy. Cystoscopy is suggested for further evaluation.

doctor
Answered by Dr. Anders Mark Christensen (28 minutes later)
Brief Answer:
A cystoscopy is a reasonable next step

Detailed Answer:
Hi Navid,

The scan suggests a malignant lesion of your urinary bladder. It is however impossible to determine whether a lesion is benign or malignant from a scan, so a cystoscopy, probably with a biopsy, is a relevant next course of action. Considering your age, malignancy is unlikely. It is always worthwhile to hear if it is possible to get an earlier appointment for the cystoscopy.

Hope this helps. Please let me know if you have further questions.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Anders Mark Christensen (22 hours later)
Thanks Dr. for your answer. based on the description, Do you consider it big one compared to other reports ? Can you suggest a couple of images that may best fit the description of the report.
doctor
Answered by Dr. Anders Mark Christensen (3 hours later)
Brief Answer:
Please elaborate

Detailed Answer:
Hi again Navid,

I do not understand your questions. Are you interested in knowing other imaging modalities that can help clarify a diagnosis?

Looking forward to hearing from you.
Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Anders Mark Christensen

General Surgeon

Practicing since :2016

Answered : 829 Questions

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Hello Doctor: I am 37, male with a history of

Brief Answer: A cystoscopy is a reasonable next step Detailed Answer: Hi Navid, The scan suggests a malignant lesion of your urinary bladder. It is however impossible to determine whether a lesion is benign or malignant from a scan, so a cystoscopy, probably with a biopsy, is a relevant next course of action. Considering your age, malignancy is unlikely. It is always worthwhile to hear if it is possible to get an earlier appointment for the cystoscopy. Hope this helps. Please let me know if you have further questions.