Professional Documents
Culture Documents
1. Urothelial (Transitional cell) carcinoma of the bladder- all are TRUE except:
2. On ultrasound all of the following are differential diagnoses of a mass originating in the bladder
wall
D) Bladder stone
3) A bladder mass with haematuria once found on ultrasound MAY initially best be appropriately
investigated with:
B) Cystoscopy only
ANSWERS
Q1 Answer C: bladder tumours may be subtle whilst carcinoma-in-situ (CIS) almost invisible to imaging so incorrect. Rest A,
B and D fairly obviously correct
Q2 Answer D: Bladder stones will be hyperechoic with acoustic shadowing when visible and so should not be mistaken for
cancer- they are also mobile. However it must be remembered that Cancers are generally isoechoic as in the case of quiz 4
but occasionally parts may be hyperechoic if calcified and hence could be mistaken as a stone. Answers A-c all good
differentials of mass arising from bladder wall
Q3 Answer A: Ultrasound is actually a valuable tool in diagnosis of haematuria (despite what some references state). The
caveat is that carcinoma-in-situ (CIS) and subtle masses will be missed necessitating cystoscopy and upper tract imaging in
almost every case. If renal tract ultrasound primary modality available must be supplemented with retrograde
pyelography- CTIVP can be done but not essential: see EAU guidelines http://www.uroweb.org/guidelines/online-
guidelines/ The BAUS guidelines state “Imaging and cystoscopy” for hematuria (haematuria) investigation
http://www.baus.org.uk/AboutBAUS/publications/haematuria-guidelines. B) must image upper tracts, C) must have
cystoscopy!