Case Discussion

The finding of blood on urine dipstick analysis led to the suspicion of renal injury in this patient who had a fall. The cause was determined to be an incidental bladder lesion. This was causing obstruction but haematuria was not noticed by the patient prior to the trauma and there were no recent blood tests which may have detected an impaired renal function or microcytic anaemia. 

Up to 75% of patients undergoing whole body trauma imaging have incidental findings detected. Whilst the majority of these will require no further investigation or treatment (such as simple renal or liver cysts), up to 40% will require either immediate or urgent investigation and/or treatment ¹. It is important to highlight important incidental findings in trauma CT reports with actionable outcomes for referring clinicians.

On follow up imaging for the breast abnormality, no lesion was detected and on subsequent CTs the findings had resolved. It was assumed that the changes seen on this CT were due to trauma.

Pathology result (abridged):

Microscopic:

The bladder tumour is a papillary transitional cell carcinoma which in most areas is grade 2/low grade. However, there are foci of grade 2/high grade tumour. Most of the tumour is non-invasive, but there are several definite foci of invasion of the lamina propria. Tumour abuts muscularis propria, but is separated from it by stromal reaction. Consequently, the formal pathological stage is pT1. The biopsies also contain fragments of detrusor muscle, which are free from tumour.