EURORAD ESR

Case 15665

Ileo-vesical fistula secondary to squamocellular bladder carcinoma

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 54 year(s)
 
 
  • Figure 1
    Unenhanced CT (due to impaired renal function) at another facility
     

    The urinary bladder contained abundant nondependent air (without recent catheterisation) and showed marked (1 cm) mural thickening (arrowhead) along its right posterolateral aspect. Note uterus (*).

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    The same pronounced mural thickening (arrowheads) involved also the bladder dome, closely adherent to non-dilated small bowel loops. No ascites was present.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 2
    Contrast-enhanced multidetector CT with CT-cystography
     

    Filled by iodinated contrast medium via Foley catheter, the urinary bladder showed marked mural thickening (arrowheads) along its right and superior aspects. Additionally, contrast was seen also in adjacent ileal loops.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Filled by iodinated contrast medium via Foley catheter, the urinary bladder showed marked mural thickening (arrowheads) along its right and superior aspects. Additionally, contrast was seen also in adjacent ileal...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Filled by iodinated contrast medium via Foley catheter, the urinary bladder showed marked mural thickening (arrowheads) along its right and superior aspects. Additionally, contrast was seen also in adjacent ileal...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Detail coronal (d) and maximum-intensity projection (e-f) images showed contrast medium flowing through double, wide fistula (arrows) connecting the bladder dome to the ileal loops. Note neoplastic bladder wall...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Detail coronal (d) and maximum-intensity projection (e-f) images showed contrast medium flowing through double, wide fistula (arrows) connecting the bladder dome to the ileal loops.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Detail coronal (d) and maximum-intensity projection (e-f) images showed contrast medium flowing through double, wide fistula (arrows) connecting the bladder dome to the ileal loops.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 3
    Post-surgical (three weeks) contrast-enhanced CT
     

    Portal venous (a,b) and excretory (c) acquisitions showed post-surgical status after radical cystectomy en bloc with ileum, lymphadenectomy and Bricker reconstruction. Note ileal conduit (thick arrows).

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Portal venous acquisition showed post-surgical status after radical cystectomy en bloc with ileum and Bricker reconstruction. Note ileal conduit (thick arrow), left-sided lymphocele (+) adjacent to lymphadenectomy...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Excretory acquisition showed post-surgical status after radical cystectomy en bloc with ileum, lymphadenectomy and Bricker reconstruction. Note ileal conduit (thick arrow) with opacified urine.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
The urinary bladder contained abundant nondependent air (without recent catheterisation) and showed marked (1 cm) mural thickening (arrowhead) along its right posterolateral aspect. Note uterus (*).
 
The same pronounced mural thickening (arrowheads) involved also the bladder dome, closely adherent to non-dilated small bowel loops. No ascites was present.
 
Filled by iodinated contrast medium via Foley catheter, the urinary bladder showed marked mural thickening (arrowheads) along its right and superior aspects. Additionally, contrast was seen also in adjacent ileal loops.
 
Filled by iodinated contrast medium via Foley catheter, the urinary bladder showed marked mural thickening (arrowheads) along its right and superior aspects. Additionally, contrast was seen also in adjacent ileal loops. Note uterus (*)
 
Filled by iodinated contrast medium via Foley catheter, the urinary bladder showed marked mural thickening (arrowheads) along its right and superior aspects. Additionally, contrast was seen also in adjacent ileal loops. Note uterus (*)
 
Detail coronal (d) and maximum-intensity projection (e-f) images showed contrast medium flowing through double, wide fistula (arrows) connecting the bladder dome to the ileal loops. Note neoplastic bladder wall thickening (arrowhead).
 
Detail coronal (d) and maximum-intensity projection (e-f) images showed contrast medium flowing through double, wide fistula (arrows) connecting the bladder dome to the ileal loops.
 
Detail coronal (d) and maximum-intensity projection (e-f) images showed contrast medium flowing through double, wide fistula (arrows) connecting the bladder dome to the ileal loops.
 
Portal venous (a,b) and excretory (c) acquisitions showed post-surgical status after radical cystectomy en bloc with ileum, lymphadenectomy and Bricker reconstruction. Note ileal conduit (thick arrows).
 
Portal venous acquisition showed post-surgical status after radical cystectomy en bloc with ileum and Bricker reconstruction. Note ileal conduit (thick arrow), left-sided lymphocele (+) adjacent to lymphadenectomy staple (thin arrow).
 
Excretory acquisition showed post-surgical status after radical cystectomy en bloc with ileum, lymphadenectomy and Bricker reconstruction. Note ileal conduit (thick arrow) with opacified urine.
 
 
 
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