Bladder mass in a 17 year old MN Siamese cat

History

A 17-year-old NM Siamese was initially presented with PU/PD, increased appetite, and a bout of vomiting and diarrhea. Weight loss was noted on physical examination. The patient was later presented again with a hematuria. Bleeding from the penis, pale mucosa, and inappropriate mentation status (sitting sternal with head down) were present on physical examination. Urinalysis showed inappropriate SG (1.018), 1+ protein, and 3+ blood. Blood pressure, CBC, and coagulation panel were all within normal limits.

A 17-year-old NM Siamese was initially presented with PU/PD, increased appetite, and a bout of vomiting and diarrhea. Weight loss was noted on physical examination. The patient was later presented again with a hematuria. Bleeding from the penis, pale mucosa, and inappropriate mentation status (sitting sternal with head down) were present on physical examination. Urinalysis showed inappropriate SG (1.018), 1+ protein, and 3+ blood. Blood pressure, CBC, and coagulation panel were all within normal limits. Abnormalities on serum biochemistry included elevated ALT activity and amylase, and azotemia.

Clinical Differential Diagnosis

Hematuria – bladder pathology (bacterial cystitis, interstitial cystitis, uroliths, neoplasia), renal pathology (neoplasia, pyelonephritis, renolith, trauma, infarction), urethral pathology (neoplasia, trauma).

DX

Bladder mass

Sampling

None. However, ultrasound-guided traumatic catheterization would be recommended prior to surgical intervention in order to obtain tissue or cytology for analyzing for a potential mass or blood clot.

Sonographic Differential Diagnosis

Urinary bladder mass or significantly attached blood clot. Given the persistence of the problem and the loss of apical wall detail in the urinary bladder, a mass is suspected. The mass appears to be deriving from the bladder apex and appears resectable. Due to thrombocytopenia, however, it would be recommended to rule out coagulopathy and the possibility of a blood clot prior to surgery.

Image Interpretation

The urinary bladder in this patient presented a 2.0 cm, mixed echogenic blood clot or mass that appeared to be attached to the apical wall. Loss of mural detail in the wall was noted, which suggests an organized mass more so than a blood clot.