Case 42
/81 yo male smoker with PMH of CVA, CAD with stents, on ASA 81mg qd, and BPH p/w atraumatic gross hematuria. No f/c/n/v. No other urinary complaints. Family also reports pt has been more SOB recently and pale.
ROS:
Eyes: No visual changes, eye pain or discharge.
Cardiac: +SOB; No chest pain with exertion.
Respiratory: No cough or respiratory distress.
GI: No nausea, vomiting, diarrhea or abdominal pain.
GU: +Hematuria
EXAM:
CONSTITUTIONAL: Well-developed; well-nourished; in no acute distress.
SKIN: Remainder of skin exam is warm and dry, no acute rash. +Pallor
EYES: PERRL, EOM intact; conjunctiva and sclera clear.
CARD: S1, S2 normal; no murmurs, gallops, or rubs. Regular rate and rhythm
RESP: No wheezes, rales or rhonchi.
ABD: Normal bowel sounds; soft; non-distended; non-tender; no hepatosplenomegaly.
GU: Blood at meatus
What is this structure? Describe the abnormality of this structure in terms of echogenicity
- What is your differential diagnosis?
3. What are the grades of Hydronephrosis. What grade does this patient have?
4. How do you measure bladder volume on ultrasound?
ANSWERS:
1.In this image we see the bladder in the transverse view, verified by the posterior acoustic enhancement posterior. There is a heterogeneously echoic mass in the bladder.
2.The ddx for a Heterogeneous bladder mass includes: clotted blood, a malignancy, Pseudosarcoma, Endometriosis, Tuberculosis and Schistosomiasis.
3. Hydronephrosis is identified on ultrasound with a grading system ranging between no hydro to severe (Grades 0-4). Figure 1 demonstrates mild - severe hydronephrosis (A-D). Our patient from the case has mild hydronephrosis
Great Resource for Hydronephrosis : http://radiopaedia.org/articles/grading-of-hydronephrosis.
4. Bladder volume is calculated by measuring the depth (D1) and width (D2) in the transverse view and the bladder length (D2) in the sagittal view. Volume = WxDxLx(0.75)
