KARPAGAM BLADDER LEIOMYOMAjjjjjjj-1.pptx

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1. KARPAGAM

2. CHIEF COMPLAINTS :42 yrs female, housewife, came with chief complaints of painless hematuria x 10 days History of presenting illness : Patient came with complaints of painless hematuria x 10 days H/O similar complains 2 years ago. No H/O fever/burning micturition /vomiting/abdominal pain. S/P cystoscopy 2 years ago in Stanley for similar complains.   PAST HISTORY: Patient is not a known case of DM/SHTN/BA/TB. S/P cystoscopy 2 years ago in Stanley.   PERSONAL HISTORY : NIL SIGNIFICANT

3. FAMILY HISTORY: Nil significant   O/E: Conscious, oriented, Afebrile VITALS: BP – 120/80 mmHG , PR – 80 /min   S/E: CVS – S1S2+ RS- BAE+ P/A – Soft, non-tender CNS – NFND GENITALS – PV – 5cm lesion palpable in anterior vaginal wall bimanually

4. INVESTIGATIONS: HB – 10.5, TC –6870, PLT – 3.29 , UREA – 26 CREATININE- 0.8 SERUM ELECTROLYTES: Na-139 ; K-3.9 ; Cl-105 ; HCO3-18   LFT- NORMAL URINE ROUTINE- pH 6.0, 1.015, blood present, RBCs plenty URINE CULTURE – no growth

5. XRAY KUB RADIOLOGY:

6. USG KUB BLADDER LEFT KIDNEY RIGHT KIDNEY

7. USG KUB: RIGHT KIDNEY: MEASURES 9.4X4.6CM. NORMAL LEFT KIDNEY: MEASURES 10X5CM. NORMAL BLADDER: A FAIRLY DEFINED HETEROECHOIC LESION OF SIZE ~5.3X5.1X5.6CM , VOLUME~80CC WITH INTRAVESICAL INTERNAL VASCULARITY ARISING FROM THE WALL OF BLADDER LIKELY POSTERIOR WAL IMPRESSION HETEROECHOIC LESION OF BLADDER

8. CECT UROGRAM

9. CECT UROGRAM RIGHT KIDNEY: MEASURES 9.4X4.6CM. NORMAL LEFT KIDNEY: MEASURES 10X5CM. NORMAL BLADDER : HOMOGENOUSLY ENHANCING SOFT TISSUE DENSITY MASS LESION MEASURING ~70 X 55 X 54 MM NOTED IN BASE OF BLADDER EXTENDING INTO PROXIMAL URETHRA AND INDENTING THE CERVIX. IMPRESSION HOMOGENOUSLY ENHANCING SOFT TISSUE DENSITY MASS LESION NOTED IN BASE OF BLADDER EXTENDING INTO PROXIMAL URETHRA AND INDENTING THE CERVIX. NO SIGNIFICANT RETROPERITONEAL/PELVIC LYMPHADENOPATHY LIKELY LEIOMYOMA BLADDER

10. PET CT WITH MRI FUSION

11. PET CT WITH MRI FUSION-IMPRESSION LARGE LOBULATED METABOLICALLY ACTIVE HETEROGENOUSLY ENHANCING T2 INTERMEDIATE SIGNAL INTRALUMINAL SOFT TISSUE MASS MEASURING ~6.8 X 5.7 X 4.7 CM NOTED ARISING FROM THE BASE OF URINARY BLADDER/BLADDER NECK WITH EXTENSION INTO THE UPPER URETHRA (SUV MAX=5) POSTERIORLY THE LESION INDENTS THE VAGINA WITH NO OBVIOUS INVASION LESION SHOWS MILD HETEROGE NOUS DIFFUSION RESTRICTION NO INVOLVEMENT OF VESICOURETERIC JUNCTION URINARY BLADDER APPEARS DIFFUSELY THICK WALLED WITH TRABECULATIONS SUGGESTIVE OF UNDERLYING CYSTITIS. BROAD BASED DIVERTICULUM IS NOTED IN THE RIGHT POSTEROLATERAL WALL OF URINARY BLADDER JUST LATERAL TO THE VUJ