Bladder walls and bananas
The bladder wall is typically altered in thickness and sometimes in uniformity, shape and contour in cases of cystitis. In this 12 yr-old female Poodle dog presented for chronic dysuria and pollakiuria, this sonographic image was suggestive of cystitis.
As we know however, the appearance of the bladder wall can be greatly influenced by the amount of luminal distension. And since that dog had been treated with several antibiotics and showed important signs of dysuria, an obstructive lesion remained suspected. It was suggested that a follow-up exam be formed with a full bladder. Here is what was seen on that second exam performed the following day…
The bladder wall was now smooth and normal in thickness. At the trigone, an irregularity was now detected and urethral wall thickening was now obvious. Ill-defined hyperechoic areas were also noted in the ventral urethral wall suggesting mineralization. These features are consistent with a transitional cell carcinoma, which was masked by the artifactual thickening of the bladder wall due to insufficient distension.
This story is not that remarkable. I’m sure you’ve experienced that more than once. Ultrasound is a great modality. But pitfalls like this one exist – a lot!- and may lead to false diagnoses.
Be careful now not to slip on those ultrasound banana peels! 🙂