KEY FACTS
Terminology
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Malignant tumor of bladder [95% transitional cell (urothelial) carcinoma]
Imaging
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Focal bladder wall thickening with intraluminal extension as mass
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Grayscale US: Immobile polypoidal or broad-based mass along bladder wall, may present as focal wall thickening
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May see associated calcification
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Color Doppler US shows increased vascularity in large tumors; power Doppler more sensitive in detection of vascularity in small tumors
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Useful for bladder tumor screening in patients with schistosomiasis, tumor within diverticulum
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CTU: Better delineation as intraluminal filling defect, screening upper urinary tract
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CT sensitivity of 85% and specificity of 94% for detecting bladder tumor
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MR: T1WI isointense to muscle/bladder wall, T2WI slightly hyperintense to muscle, early postgadolinium enhancement
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High accuracy for locoregional spread, accuracy of ~ 85% in differentiating nonmuscle invasive from muscle invasive tumor
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± enlarged (> 10 mm) metastatic lymph nodes
Top Differential Diagnoses
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Benign prostatic hypertrophy
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Bladder debris &/or blood clot
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Extrinsic tumor/mass
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Bladder inflammation
Pathology
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Superficial (70-80%) and are usually papillary (70%)
Clinical Issues
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Painless hematuria
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If tumor near UVJ, may cause hydronephrosis
Scanning Tips
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Check kidneys, ureters for synchronous and metachronous tumors
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Optimize color and power Doppler frequency and scale to demonstrate subtle vascularity
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Roll patient or ask patient to cough to demonstrate if bladder lesion is attached to wall
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Layering debris or blood clot often present and may obscure delineation of tumor
