BLADDER

• Filling defects
  • Bladder carcinoma
  • Blood clots
  • Stones
• Abnormal shape or position
  • Pelvic masses
    • Abscess
    • Cervical neoplasms (ref)
    • Ovarian neoplasms (ref)
    • Prostatic hypertrophy (ref)
    • Prostatic carcinoma (ref)
    • Uterine neoplasms (ref)
  • Prolapse (ref )

Normally the bladder is visualized on bone scintigrams, as diphosphonates are excreted by the kidneys. A large quantity of activity in the bladder may obscure the pelvic bones. Bladder diverticula may be misinterpreted as pubic lesions. Distortion of the bladder by pelvic masses (uterine, cervical, ovarian, prostatic neoplasms), filling defects in the bladder (bladder carcinoma, stones, blood clots) or abnormal position of the bladder (bladder prolapse) may be detected on bone scintigrams.

Bladder carcinoma .

A large photon deficient lesion (arrow) is seen in the superior aspect of the bladder on the bone scintigram (A) and corresponds to a filling defect seen on a radiograph of the pelvis (B) obtained during the intravenous pyelogram.
 

Bladder prolapse.

The bone scintigram demonstrates a collection of activity below the symphysis pubis in the absence of activity in the usual location of the urinary bladder. Physical examination reveals a prolapsed bladder.

 

Benign Prostatic Hypertrophy

Bone scintigram (anterior view) shows superior displacement of the bladder.
 

Prostate Carcinoma

Bone scintigram (A) shows superior displacement of the bladder. CT scan (B) shows a large mass invading and displacing the bladder. This patient has carcinoma of the prostate.

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Pelvic Abscess

(A) Bone scintigram (anterior view) shows displacement of the bladder to the right, a finding that corresponds to a large pelvic abscess seen on CT scan (B).

 

Fibroid

(A) Bone scintigram (anterior view) shows increased uptake above the bladder to the left, a finding that corresponds to a large calcified fibroid on the CT scan (B).