British Journal of Radiology (2007) 80, e113-e114
© 2007 British Institute of Radiology
doi: 10.1259/bjr/25717276
Ultrasound guided location and resection of a suburothelial cavernous haemangioma of the bladder
S J Bromage, MBBS, BMedSci, MRCS
L Chan, MBBS DDU, FRACS
and
R L Collins, MBBS, BMedSci, FRCS(UrolUK)
Departments of Urology and Anatomical Pathology, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia
Correspondence: Stephen Bromage, Department of Urology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. E-mail: sjbromage{at}doctors.org.uk
 |
Abstract
|
|---|
Complete endoscopic resection of bladder tumours can be difficult. This is particularly true when there is normal overlying mucosa, as in a cavernous haemangioma. We describe a case where intraoperative ultrasound was used to guide successful endoscopic resection.
|
Introduction
|
|---|
Primary non-urothelial bladder tumours are uncommon and arise from the muscle and/or connective tissue elements of the bladder wall. Cavernous haemangiomas of the bladder are rare tumours with approximately 100 cases reported in the literature to date [1]. They arise from the suburothelial vasculature and are typically benign. Presentation is commonly with frank haematuria after the lesion has breached the urothelium, presenting as an exophytic bladder lesion. Endoscopic examination of the bladder would typically identify an exophytic lesion, but if the mucosa has not been breached, cystoscopic findings may be minimal. Ultrasound has been used to guide the endoscopic resection of gastrointestinal tumours [2] and has been used intraoperatively to confirm complete resection of testicular tumours [3]. We describe a technique of utilizing ultrasound to guide complete excision of a suburothelial bladder lesion.
|
Case report
|
|---|
A 39-year-old woman presented with microscopic haematuria on a background of 12 months of suprapubic pain. Transabdominal and transvaginal ultrasound identified a 2–3 cm lesion within the bladder, reported to be an exophytic bladder tumour (Figure 1a
). However, endoscopic examination showed no bladder mucosal abnormalities, although a midline bulge in the mucosa posteriorly could be identified (Figure 2). Using cystoscopy alone, it was difficult to determine whether the mucosal bulge represented the lesion seen on ultrasound or uterine compression. A repeat cystoscopy was performed with ultrasound guidance by a qualified ultrasonograher using a Sonosite (Hitchin, UK) Titan with a C2–5 MHz convex abdominal probe. This clearly identified the lesion, as shown in Figure 1b. A standard 26 French resectoscope was then used to excise this lesion. Ultrasound easily demonstrated the resection and when the mucosa appeared flat on the ultrasound images the resection was halted. At this stage there were no longer any abnormalities detected with ultrasound. A post-operative ultrasound image is shown in Figure 1c. The histology showed fragments of a cavernous haemangioma involving the muscle wall. A few fragments were partly covered by normal urothelium.
View larger version (55K):
[in this window]
[in a new window]
|
Figure 1. (a) Initial transabdominal ultrasound which identified a bladder lesion. (b) Transabdominal ultrasound of the resectosope inside the bladder prior to resection of the bladder lesion. (c) Post-operative transabdominal ultrasound demonstrating no abnormalities.
|
|
|
Discussion
|
|---|
Ultrasound-guided resection is not routinely required as the vast majority of bladder lesions are clearly identifiable on cystoscopy. However, in cases where the location of a bladder lesion is difficult, particularly if there is normal overlying mucosa, simultaneous use of both modalities can be of value. Ultrasound assistance can help to both identify the lesion and confirm its complete resection. Ultrasound is a non-invasive, safe form of imaging that is effective at identifying mucosal bladder lesions. This technique does require some basic ultrasound training and may be difficult in poor subjects, such as obese patients.
We have shown ultrasound to be a valuable tool intraoperatively in the resection of certain bladder lesions.
Received for publication October 3, 2005.
Revision received February 9, 2006.
Accepted for publication February 13, 2006.
|
References
|
|---|
- Cheng L, Nascimento AG, Neumann RM, Nehra A, Cheville JC, Ramnani DM, et al. Haemangioma of the urinary bladder. Cancer 1999;86:498–504.[CrossRef][Medline]
- Martinez Ares D, Souto Ruzo J, Varas Lorenzo M, Espinos Perez J, Ysnez Lopez J, Abad Belando R, et al. Endoscopic ultrasound-assisted endoscopic resection of carcinoid tumours of the gastrointestinal tract. Rev Enferm Dig 2004;96:847–55.
- Buckspan MB, Klotz PG, Goldfinger M, Stoll S, Fernandes B. Intraoperative ultrasound in the conservative management of testicular neoplasms. J Urol 1989;141:326–7.[Medline]
Top
Abstract
Introduction
