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Intraoperative decision to change the course of management based on an ultrasonographic image of urinary bladder paraganglioma – a case study

Waldemar Białek
Waldemar Białek
, 
Piotr Kawecki
Piotr Kawecki
, 
Katarzyna Dyndor
Katarzyna Dyndor
, 
Lech Wronecki
Lech Wronecki
 and 
Sławomir Rudzki
Sławomir Rudzki
   | Jun 28, 2019
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Article Category: case-report
Published Online: Jun 28, 2019
Page range: 165 - 170
Received: Sep 30, 2018
Accepted: Nov 03, 2018
DOI: https://doi.org/10.15557/jou.2019.0025
Keywords
© 2019 Waldemar Białek et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Cystoscopic image of a urinary bladder tumor. A rich submucosal vascular network is conspicuously displayed; mucosa adjacent to tumor is unchanged
Cystoscopic image of a urinary bladder tumor. A rich submucosal vascular network is conspicuously displayed; mucosa adjacent to tumor is unchanged

Fig. 2.

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
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

Fig. 3.

Urinary bladder image in transabdominal examination in sagittal plain. Tumor infiltrating through a bladder wall and adjacent to cervix. Examination conducted with ProFocus Ultraview, BK Medical, 8820e, 5 MHz probe
Urinary bladder image in transabdominal examination in sagittal plain. Tumor infiltrating through a bladder wall and adjacent to cervix. Examination conducted with ProFocus Ultraview, BK Medical, 8820e, 5 MHz probe

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
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

Fig. 5.

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
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

Fig. 6.

Urinary bladder image in trans-vaginal examination in sagittal plain in color Doppler. A rich submucosal vascular network, which supplies tumor from the side of cervix, is conspicuously displayed. Examination conducted with ProFocus Ultraview, BK Medical, a 8818, 12 MHz probe
Urinary bladder image in trans-vaginal examination in sagittal plain in color Doppler. A rich submucosal vascular network, which supplies tumor from the side of cervix, is conspicuously displayed. Examination conducted with ProFocus Ultraview, BK Medical, a 8818, 12 MHz probe

Fig. 7.

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
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

Fig. 8.

Urinary bladder scans in trans-abdominal examination with a volumetric head allow for precise assessment of tumor’s extent in relation to a uterus. Examination conducted with Toshiba Aplio 500, an endovaginal 9CV3 probe
Urinary bladder scans in trans-abdominal examination with a volumetric head allow for precise assessment of tumor’s extent in relation to a uterus. Examination conducted with Toshiba Aplio 500, an endovaginal 9CV3 probe

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
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

Fig. 10.

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
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

Fig. 11.

CT examination with intravenous injection of a contrast medium, delayed phase after 15 minutes, axial section. On the right in the wall of urinary bladder, a filling defect is visible, which corresponds with phaeochromocytoma
CT examination with intravenous injection of a contrast medium, delayed phase after 15 minutes, axial section. On the right in the wall of urinary bladder, a filling defect is visible, which corresponds with phaeochromocytoma

Fig. 12.

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
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

Fig. 13.

Pheochromocytoma in diffusion imaging (two b values:50, 600), in correlation with apparent diffusion coefficient map (ADC); ratio calculated automatically with diagnostic station software. Axial scans image pathological tissue with moderate traits of water diffusion restriction
Pheochromocytoma in diffusion imaging (two b values:50, 600), in correlation with apparent diffusion coefficient map (ADC); ratio calculated automatically with diagnostic station software. Axial scans image pathological tissue with moderate traits of water diffusion restriction
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