Urinary Bladder Mass Invading the Right Ureter in an 11-Year-Old FS Pit Bull Terrier: Our Case Of the Month July 2018

Patient Information

Age

11 Years

Gender

Female, Spayed

Species

Canine

Keywords

Clinical Signs

Hematuria

Images

Left kidney.

Urinary bladder mass.

Mass, irregular wall at ureteral papilla. Clean urethra.

Bladder mass transverse.

Right ureteral obstruction.

Right ureteral invasion.

Ureter.

Hematuria, stranguria, pollakuria, and any sort of “uria” needs a probe. Living by “If it's sick it needs a probe” will always provide direction in a case. But when hematuria leads to the sonographic diagnosis of a bladder mass, it's important to define it well sonographically to decide which treatment to pursue, whether surgery or other. With the availability of UGELAB, urinary stents, SUB (subcutaneous ureteral bybass) devices and even artificial neobladders, the clinical sonographer’s job is to define the crucial structures for interventional planning. This is exactly one of those cases where the pelvic urethra, CUJ (cystourethral junction), trigone and ureters have a story to tell when invaded by this carcinoma. Watch Andi Parkinson of Intrapet Imaging. Baltimore, MD, USA show her sonographic footprint while artistically demonstrating this TCC (transitional cell carcinoma) invading the right ureter but still clean in the CUJ and urethra. Probe wielding colleagues I say... this is just how we do it and Andi is setting the bar. :)

History

The patient was presented with history of intermittent hematuria of 13 months duration. Most recent medications given were Augmentin and then Cephalexin a month later. Blood work was unremarkable. Urine culture and sensitivity showed E Coli sensitivity to Clavamox and Cephalexin.

Image Interpretation

The urinary bladder revealed a dorsal wall mass that measured 3.0 cm. The mass was moderately vascular. The right ureter was slightly dilated at 0.28 cm. The pelvic urethra was imaged 3.0 cm beyond the cystourethral junction. There were slight wall irregularities noted at the ureteral papilla. The urethra appeared to be free of evident pathology as did the cystourethral junction. The mass presented intramural encroachment on the right ureteral papilla causing secondary dilation and rendering this mass non-resectable unless ureteral transposition is to be performed given the early obstruction.

DX

Dorsal bladder mass encroaching upon the right ureteral papilla with early obstruction.

Outcome

Ureteral stent placement may be the best option with chemoreduction or surgical reduction of the bladder mass. Neither kidney revealed pyelectasia at the time of imaging. There was suspicion of developing pyelectasia of the right kidney over time. Invasion of the right ureter appeared to be present in the last 1.0 cm of the ureter. A guarded to poor long term prognosis was given.