General Jose

Case

C#{224}ceres, MD

Lluis

Donoso,

of the

#{149} Jose

M. Mata,

Day1 MD

#{149} Javier

Lucaya,

HISTORY

U

#{149} Jaume

RADIOLOGIC

U

An 8-year-old

girl was

admitted

with

Plain

gross

Palmer,

MD

tomography (Figs 1-5).

(CT)

were

FINDINGS

radiography

of the

strated multiple, round soft tissues of the pelvis

painless hematunia. She had no other symptoms, and results of physical examination and laboratory tests were normal. Plain radiography, excretory unography, and computed formed

MD

MD

pen-

abdomen

demon-

calcifications (Fig 1) After

in the

the

.

administration

al, filling seen (Fig

defects in the bladder wall were 2) These findings were more cvi-

dent

of contrast

in-

travenous

mateni-

.

on the postvoiding

images,

which

also

2.

1.

Figures 1-3. (2) Excretory

(1) Plain abdominal radiograph. urogram obtained before voiding shows filling defects (arrows) . (3) Postvoiding excretory urogram.

3.

Index 83.3

terms:

Angioma.

RadioGraplilcs I

From

&

January

1991;

the

celona, celona sion

genitourina’

system.

83.3i8

Bladder

neoplasms,

#{149}

83.3i8

Bladder

#{149}

neoplasms,

in infants

and

children,

18

Department

Spain (iL.); requested

RSNA.

1991

11:161-163 of Diagnostic

(J.C.,J.M.M..J.P., and the tJniversitat October

25;

Radiology,

Hospital

de

Ia Santa

L.D.); the Department ofDiagnostic Aut#{243}noma de Barcelona. From

revision

received

and

accepted

the

November

Creu

i Sant

Pau,

Avenida

Radiology, Clinica 1990 RSNA scientific i3.

Address

San

Infantil de assembly.

reprint

Antonio

Maria

Ia Ciudad Received

requests

Claret

Sanitaria October

i67.

08025

Bar-

Vail d’Flebr#{243}n, Bar10, 1990; revi-

toJ.C.

1991

C#{225}ceres et al

U

RadioGrapbics

U

161

Figures pelvis.

4, 5.

(4) Unenhanced CT scans obtained

(5)

Figure 4 before enhancement.

revealed

(a)

that

CT scan at a lower

and after

(b)

the calcifications

contrast

defects

the

within thick-

mmon the cysto-

.

the filling

material

followed

contour of the bladder (Fig 3). CT demonstrated the calcifications the bladder wall, which was focally ened (Fig 4) The areas of thickening

nored

of the level than

seen

gram. CT scans obtained at a lower level before (Fig 5a) and after (Fig Sb) intravenous administration of contrast material showed en-

hancement

(32-80

HU)

of the thickened

area.

collection gestive locations,

U CYSTOSCOPIC FINDINGS Several areas of angiomatous vessels were found, with hyperemic mucosa. Although

there

was

sy was

and

graphic hallmark of this of phleboliths in an area

dissent

performed,

focal

about and

hemorrhage

DIAGNOSIS:

the were

Hemangioma

procedure,

submucosal

biopedema

(1)

be is highly sug, even in atypical

case.

bladder

tumors,

and

fewer

than

1 00 cases

have been reported in the literature. Associated cutaneous hemangiomas over the abdomen, perineum, and thighs occur in about

bladder.

U DISCUSSION Cavernous hemangioma is not infrequent striated muscles of the extremities. They contain phleboliths, which are the radio-

should

The presence no normal

Hemangiomas of the bladder are uncommon. They represent 0.6% of all primary

found. of the

of veins of hemangioma as in this

tumor. where

in may

25%-30% of cases. It is estimated tween 3% and 6% of patients with Tr#{233}naunay syndrome have bladder omas (2). Gross painless hematunia is the

mon

presenting

symptom.

that beKlippelhemangimost

At the time

com-

of pre-

sentation, more than half of the patients with bladder hemangiomas are less than 20 years old. There is no sex predilection. The size of

the

162

U

Ra4ioGrapbics

U

C#{225}ceres et al

lesions

may vary

from

tiny

growths

Volume

to

11

Number

1

bleed easily. Although there is some disagreement, it is generally believed that biopsy should be avoided to prevent bleed-

ing (3). In large

tumors,

ommended.

mas,

surgical

In small

the treatment

resection

or diffuse

is nec-

hemangio-

of choice

is photocauteni-

zation with a laser (6) , and this procedure was performed on our patient. A S-year follow-up CT examination did not demonstrate further growth of the tumor (Fig 6) Intermittent hematunia was controlled with laser therapy. .

Figure 6. CT scan after laser therapy.

of the pelvis

obtained

5 years

1.

large masses. Two-thirds of bladder hemangiomas are solitary and may be located anywhere, although they favor the bladder dome or its posterolateral walls. Involvement of

the uretenal

U

orifices

or the bladder

neck

2.

3

4.

.

tumors.

In: Wilner

D,

tumors

and allied

dis-

Saunders,

1982;

orders. Philadelphia: 4054. Hall BD. Bladder

hemangiomas

Tr#{233}naunay-Weber

syndrome.

1971;

is

rare. The diagnosis of bladder hemangioma has classically been made by means of excretory unognaphy, cystography, and cystoscopy. On contrast material-enhanced studies, these tumors appear as filling defects in the bladder and are more or less obvious, depending on tumor size. In about half of the cases, no abnormalities are seen at plain radiography and intravenous urography on cystography (3). As mentioned earlier, the presence of phleboliths is suggestive of this entity, especially in children and patients under 20 years of age. CT and ultrasound have recently been employed to diagnose bladder hemangioma (4 ,S) CT gives a better anatomic definition of the lesion and helps in the evaluation of extravesical spread, when it occurs.

REFERENCES Wilner D. Soft tissue ed. Radiology of bone

Hendry bladder

140:601-602. Gupta AK,

Bhargava

ultrasonographic 6.

EnglJ

Med

WF, Vinnicombe J. Hemangioma of in children and young adults. BrJ

Urol 1971; 43:309-3 Pakter R, Nussbaum

1987;

in Klippel-

New

285:1032-1033.

16. A, Fishman

gioma of the bladder: puterized tomography 5.

4053-

sonographic findings. S.

Bladder

demonstration.

EK.

Heman-

and comJ Urol 1988; hemangioma:

Urol

Radiol

9:181-182.

Hockiey NM, Bihrle R, Bennet JM. Congenital genitourinary in a patient

with

the

RM III, Curry hemangiomas

Kiippel-Tr#{233}naunay

syn-

drome: management with the neodymium: YAGlaser.JUrol 1989; 141:940-941.

.

The

diagnosis

cystoscopy,

which

ed colons, tumors

January

1991

ranging are

usually

is confirmed reveals

from sessile

by means lesions

red to navy and

of

of variegat-

blue.

lobulated

The and

C#{225}ceres et al

U

Ra4ioGrapbics

U

163