Presentation
Suspected abdominal mass. The patient has not reported any symptoms related to the urinary tract.
Patient Data
An ill-defined complex solid and cystic mass in the pancreatic neck region measuring approximately 3.4 x 3.1 x 3.6 cm. There is complete encasement of the splenic vein with thrombosis of the distal splenic vein. The lesion also encases the celiac access, with a subtle abutment of the gastric greater curvature (probable pancreatic neoplasm).
Multifocal hypodense areas in the spleen (? infarct).
There is evidence of caudal descent of the urinary bladder, below the level of pubococcygeal line. The bladder trigone is prolapsed and there is associated bilateral hydroureteronephrosis.
Mild spondylolisthesis of L5 over S1 with bilateral fracture interarticularis of L5.
The midline sagittal image shows the urinary bladder 1.27 cm caudal to the level of the pubococcygeal line.
Case Discussion
Urinary bladder prolapse should be considered as a cause of bilateral hydroureteronephrosis in postmenopausal women.
This case illustrates the importance of recognizing significant unexpected findings; in this case a pancreatic mass that requires further evaluation.
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