Unusual bladder scan Is this just clots or is it tumour?

RE: Unusual bladder scan Is this just clots or is it tumour?

Sarah Keir — Mon, 31 Jul 2023 11:50:24 GMT

As a vet that does lots of imaging, I would caution the use of Doppler assessment unless the person doing the imaging is used to using doppler and understands how it works and the artifacts that can appear by its use.

RE: Unusual bladder scan Is this just clots or is it tumour?

hilary warner — Sun, 30 Jul 2023 23:28:20 GMT

I have seen something like this before when a dog landed badly on a fence, is there any history of trauma?

RE: Unusual bladder scan Is this just clots or is it tumour?

Mellora Sharman — Wed, 26 Jul 2023 21:39:32 GMT

Thanks Charlotte for the update - interesting that culture is negative. Is the UA still showing haematuria, but just negative culture?

Mayank's colleague provides some good advice around looking at Doppler, positioning and changing of the change over time. It's perhaps atypical for haematoma from my experience, but I agree important to consider - this doesn't look like a tumour so much to me.

I guess the question beyond that is if we do have blood clots - why. Significant haematuria might be associated with a systemic or localised disorder. Systemic disease might result in a vasculitis or coagulopathy, so evaluating for this might be important. If we have localised disease, significant urinary tract bleeding might relate to a focal lesion such as a tumour that we just can't see right now - so reassessment would be wise from that perspective if we are unable to properly assess for mobility in a wiggly little puglet.

Infectious disease might remain possible and correlating your culture results with the sediment examination would be wise. As before I don't see any urolithiasis, but would be curious to ensure we haven't documented any nephro- or ureteroliths.

Another important differential to consider might be primary renal haematuria. This might be diagnosed after exclusion of other causes +/- cystoscopy to confirm bleeding within ureteral jets (important to do during episodes).

I hope this helps with some next steps.

Best Wishes,

Mellora

RE: Unusual bladder scan Is this just clots or is it tumour?

Mayank Seth — Wed, 26 Jul 2023 20:24:37 GMT

Hi Charlotte

I asked a radiologist colleague about this case and I'm just going to cut/paste what he said rather than trying to paraphrase:

I would assume it is a blood clot personally with that appearance in a dog with recent haematuria.It is not the typical appearance of any common bladder tumour. I would recommend doppler assessment as tumours of the bladder are typically very vascular and haematomas obviously are not. I would also recommend scanning the dog in different recumbencies to see if this material is mobile or adherent to the bladder wall. A mass would obviously be confluent with a regional thickening of the bladder wall and would not just sit against the wall. These clots can change appearance quite quickly as the organises and contract. Serial monitoring over a few days or weeks should help differentiate between mass (static or growing) and clot (hopefully resolving). With that degree of haematuria I would be more interested in seeing the rest of the urinary tract to find the source. I would also not like to say there is no tumour underlying this clot (even if most of this material is more likely to represent the clot in my opinion).

Do let us know what you find!

Mayank

RE: Unusual bladder scan Is this just clots or is it tumour?

Charlotte Marshall — Wed, 26 Jul 2023 15:17:51 GMT

Urine culture has just come back negative. To be honest the dog was a bit wriggly so I couldn't really say how mobile it might be.

We wondered maybe if we should try doing a catheter aspirate for cytology? Unfortunately cost is a bit of a worry for the owner otherwise I would probably refer it!

RE: Unusual bladder scan Is this just clots or is it tumour?

Mellora Sharman — Wed, 26 Jul 2023 08:47:27 GMT

HI Charlotte!

Wow - how interesting and unusual. Was this material mobile when you changed positions at all?

I agree that this doesn't look compatible with clots or a tumour to me. we have what look to be pockets of fluid, but almost walled off by soft tissue material. There's no obvious acoustic shadowing for me to suggest that we have urolithiasis.

Do you have any UA findings including sediment examination +/- culture to share with these images?

Best Wishes,

Mellora Sharman BVSc MVM PGradCert PhD FANZCVS DECVIM-CA FHEA MRCVS