Case Study

06_00203 Tai Chi H Urethral mass with ureteral invasion, suspect TCC

A 12-year-old SF Aussie was presented for evaluation of a 2-3 month duration of stranguria, pollakuria, and urination accidents in the house. Treated initially with amoxicillin and then with TMS with no response. Free catch urine culture yielded pseudomonas. Current therapy is fluoroquinolone but still with no response. Appetite and activity are both normal.

Sonographic Differential Diagnosis

Aggressive, expansive urethral mass with left ureteral invasion and obstruction.
Secondary left hydronephrosis.
Ultrasound-guided laser ablation +/- ureteral stent placement is recommended. There was no overt evidence of metastatic disease.

Image Interpretation

The bladder revealed a urethral mass that extended approximately 4.0 cm distal from the cystourethral junction invading the trigone and invading the left ureter to approximately 2.0 cm craniodorsal from the trigone. The mass presented multifocal areas of mineralization. This is consistent with transitional cell carcinoma. The apical portion of the bladder also revealed micropolypoid changes. The right ureter appeared slightly invaded as well.
The left kidney in this patient presented mild to moderate hydronephrosis with hydroureter which measured 1.0 cm. Pyelectasia of the left kidney was noted and measured 1.4 x 2.0 cm. The left kidney itself measured 5.92 cm. The right kidney was unremarkable and normal in size and contour. The right kidney measured 5.95 cm.