COTW 9/20 : A 61 yo M presents with gross hematuria

61 yom, hx of HTN, presents with 3 days of gross hematuria and urinary retention.

He endorses three days of gross hematuria, associated with inability to empty his bladder fully.

He denies any trauma, flank pain, abdominal pain, fever/ chills, dysuria, or prior similar symptoms.

Right Kidney: Notable for moderate hydronephrosis

Applying Color flow confirms evidence of hydronephrosis

A look at his Left Kidney… also notable for moderate hydronephrosis ( Color was also applied in a separate image)

Bladder view: …. is that an enlarged prostate? a mass? large blood clots?

The Sagittal view helps further differentiate whether this is a mass or enlarged prostate- this view is KEY !

Adding color flow -> reveals a hypervascular mass within the bladder.. most concerning for a bladder mass

The presence of bilateral hydronephrosis, along with a vascular echogenic mass within the lumen of the bladder, was most consistent with a large bladder malignancy that was causing obstruction. In most cases of bladder masses, which may present as gross hematuria- are most commonly found on cystoscopy. However, in this case, the mass was large enough and very prominent on ultrasound. Making sure to gather a variety of views, utilize color flow, and recognize an obstructive process were crucial in this case.