Slideshow
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CT inverted bladder venous collateralization
CT urogram showing a pear-shaped inverted bladder with extensive venous collateralization.
The patient is a 54-year-old Caucasian male with a history of hidroadenitis who presented with a 1-week history of painless gross hematuria. His past medical history is otherwise unremarkable.
He underwent a CT urogram in the emergency department that revealed an inverted pear-shaped bladder due to hypertrophy of perivesical and perirectal fat as well as engorgement of the perivesical and prostatic venous plexuses, bilateral varicoceles, and engorged veins in the groins bilaterally.
Submit your diagnosis to see full explanation.
This clinical quiz was prepared by Marc C. Smaldone, MD, MSHP, FACS, of Fox Chase Cancer Center, Philadelphia.
References
1. Prabakaran R, Abraham G, Kurien A, et al. Pelvic lipomatosis. Kidney Int. 2016 90:453. doi: 10.1016/j.kint.2016.05.009.
2. National Center for Advancing Translational Sciences. Pelvic lipomatosis. https://rarediseases.info.nih.gov/diseases/7350/pelvic-lipomatosis
Answer: E
Explanation
Pelvic lipomatosis, which is a rare benign disease of unknown etiology, results in overgrowth of mature non-cancerous fat cells in the pelvis. It is most commonly seen in elderly, obese, black males with hypertension.1 Symptoms from pelvic lipomatosis are related to compression of the urinary, lower intestinal, and vascular system. Although there are no established treatment guidelines, interventions are aimed towards relief of obstruction. While most cases never progress towards symptom development, upper urinary tract surgery is occasionally required for cases of severe symptomatology or those with evidence of urinary tract obstruction with deterioration of kidney function.2
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