PMC6750317_01
Cystoscopic image of a urinary bladder tumor. A rich submucosal vascular network is conspicuously displayed; mucosa adjacent to tumor is unchanged
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fig1
During the surgery, a tumor ca. 25 mm in diameter, with a smooth surface and a rich network of curved submucosal vessels was found on a posterior bladder wall (Fig. 1).
Urinary bladder image in trans-abdominal examination in transverse plain. Tumor infiltrating through a bladder wall and adjacent to a cervix. Examination conducted with ProFocus Ultraview, BK Medical, 8820e probe, 5 MHz
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fig2
Since a cystoscopic image did not correspond with typical urothelial leasion, an intraoperative ultrasonographic transvaginal examination was carried out (Fig. 2, Fig. 3, Fig. 4).
Urinary bladder image in transvaginal examination in transverse plain. Tumor seems to invade a vaginal wall. Examination conducted with ProFocus Ultraview, BK Medical, a 8818, 12 MHz probe
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fig4
Since a cystoscopic image did not correspond with typical urothelial leasion, an intraoperative ultrasonographic transvaginal examination was carried out (Fig. 2, Fig. 3, Fig. 4).
Urinary bladder image in transvaginal examination in transverse plain in color Doppler. A rich submucosal vascular network, which supplies the tumor, is conspicuously displayed. Examination conducted with ProFocus Ultraview, BK Medical, 8818, 12 MHz probe
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fig5
In color Doppler, a signal of very rich vascular flow was registered, which is untypical for urothelial tumors (Fig. 5, Fig. 6).
Urinary bladder image in transvaginal examination in sagittal plain in color Doppler with a blood flow spectrum in a blood vessel supplying tumor (carried out a few days after intraoperative examination). Examination conducted with Toshiba Aplio 500, an endovaginal 9 MHz probe
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fig7
After the surgery, the patient was informed about the reasons for transurethral resection abandoning and the need for further examination (Fig. 7, Fig. 8, Fig. 9).
Three-dimensional reconstruction of a urinary bladder wall with tumor carried out with volumetric scanning probe. Ultra-sonographic visualization of urinary bladder wall - sonocystoscopy accurately corresponds with cystoscopy. Examination conducted with Toshiba Aplio 500, an endovaginal 9CV3 probe
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fig9
After the surgery, the patient was informed about the reasons for transurethral resection abandoning and the need for further examination (Fig. 7, Fig. 8, Fig. 9).
CT examination with intravenous injection of a contrast medium, arterial phase, axial section. On the right in the wall of urinary bladder, a smoothly outlined structure with intensive enhancement is visible, which corresponds with phaeochromocytoma
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fig10
A CT examination of the abdomen and the pelvis was carried out (Fig. 10, Fig. 11), as well as a MR examination of the pelvis (Fig. 12, Fig. 13).
Phaeochromocytoma in magnetic resonance examination in axial section. In T1-dependant sequence of gradient echo with adipose tissue saturation and intravenous application of paramagnetic contrast medium, presence of phaeochromocytoma with intensive enhancement was confirmed
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fig12
A CT examination of the abdomen and the pelvis was carried out (Fig. 10, Fig. 11), as well as a MR examination of the pelvis (Fig. 12, Fig. 13).