Clinical History: A 55-year-old male referred for ultrasound examination of the urinary bladder for diagnostic evaluation symptoms to include (hematuria, dysuria, frequency, pain).
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| Fig-1. Ultrasound image of the urinary bladder shows an irregular echogenic intraluminal mass arising from the bladder wall, demonstrating internal vascularity on color Doppler. Findings are suggestive of a papillary urothelial carcinoma (bladder tumour). |
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Fig-2.
Key point- a-Exophytic / papillary mass b-Vascular flow within lesion (rules out clot) c-Projects into lumen d-Arises from bladder wall |
Why Papillary Urothelial Carcinoma?
This lesion is suspected to be papillary urothelial carcinoma because it shows the classic ultrasound characteristics of this tumor type:
Papillary / Polypoid Appearance- The mass projects into the bladder lumen rather than thickening the wall diffusely.
Papillary tumors grow as finger-like or frond-like projections, which appear as an intraluminal echogenic mass on ultrasound.
Attachment to Bladder Wall- The lesion arises from the bladder wall, a typical origin of urothelial tumors.
Internal Vascularity on Color Doppler- Presence of internal blood flow confirms that this is a solid, viable tumor, not a clot or debris. Papillary urothelial carcinomas are usually vascular, unlike blood clots (which show no flow).
Irregular Surface but Preserved Bladder Lumen- Early or papillary tumors often show irregular margins without complete wall destruction. This appearance fits papillary carcinoma rather than infiltrative muscle-invasive disease.
Typical Clinical Correlation- Most patients present with painless hematuria, which is the hallmark symptom of papillary urothelial carcinoma.
Why NOT ?
• Bladder polyp –
• Blood clots –
• Sludge / debris –
• Inflammatory pseudotumor –
| Condition | Key Ultrasound Features |
|---|---|
| Papillary urothelial carcinoma |
✔ Fixed intraluminal bladder mass ✔ Arises from the bladder wall ✔ Irregular papillary surface ✔ Internal vascularity on Color Doppler |
| Bladder polyp |
✖ Usually small and smooth ✖ Minimal or absent Doppler vascularity ✖ Typically benign |
| Blood clot |
✖ No internal vascularity ✖ Often mobile or changes position ✖ Not attached to the bladder wall |
| Sludge / debris |
✖ Non-vascular ✖ Gravity dependent and mobile ✖ Settles in the dependent portion of the bladder |
| Inflammatory pseudotumor |
✖ Ill-defined mass or focal wall thickening ✖ Lacks typical papillary architecture ✖ Variable or minimal vascularity |
Bladder polyp
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| Fig-3. A bladder polyp is a benign mucosal growth arising from the bladder wall. It is usually small, smooth, and well-defined. Doppler study typically shows little or no internal vascularity. Polyps are fixed to the bladder wall but lack aggressive features. |
Blood clot
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| Fig-4. A blood clot or hematoma represents intravesical hemorrhage rather than a true mass. It has no internal vascularity on color Doppler and often changes position with patient movement or bladder filling. Blood clots are not attached to the bladder wall. |
Sludge / debris
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| Fig-5. Sludge or debris consists of cellular material, pus, or blood products within the urine. It is non-vascular, gravity dependent, and mobile, settling in the dependent portion of the bladder. It does not form a true mass and lacks wall attachment. |
Inflammatory pseudotumor
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| Fig-6. An inflammatory pseudotumor is a benign inflammatory lesion that can mimic a neoplasm. It usually presents as focal bladder wall thickening or an ill-defined mass. Vascularity may be variable, but papillary architecture is typically absent. |
Findings:
An exophytic papillary mass is visualized arising from the urinary bladder wall,
measuring approximately 45 × 34 mm. The lesion projects into the bladder
lumen and appears fixed at its point of attachment. Internal vascular flow is
demonstrated on color Doppler imaging, confirming the solid nature of the lesion
and excluding an intravesical blood clot. The surrounding bladder wall at the
site of origin shows focal involvement.
Conclusion:
Exophytic papillary intraluminal bladder mass arising from the bladder wall with
internal vascularity, favoring a papillary urothelial tumor
[? papillary urothelial carcinoma (TCC)].
Recommendation:
Urology consultation is advised. Cystoscopic evaluation with biopsy or
transurethral resection is recommended for histopathological confirmation.
Further staging workup may be considered based on histology.
End of Case Study
You have reached the end of this Urinary Bladder Tumor – Ultrasound Case Study.
Content is intended for educational, training, and clinical reference only.
Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled
“Exophytic Papillary Bladder Mass on Ultrasound” has been prepared solely
for educational and academic purposes.
The imaging findings, measurements, and interpretations are intended for
learning and demonstration only.
Definitive diagnosis requires clinical correlation, cystoscopic evaluation,
histopathological confirmation, and appropriate specialist consultation.
Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Uro-Radiology
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology
