Foreign body in the urinary bladder

Clinical History

11-year-old boy was consulted by our medical centre in August 2013. He presented the following symptoms: sharp pain in the lower abdomen during the last 4-5 days and feverish. The patient had an ultrasound previously with the final diagnosis: suspect urinary bladder mass.

Imaging Findings

During renal CT angiography with urographic phases at the 15th and 20th min, it was revealed a low attenuated solitary mass in the urinary bladder, adjacent to the bladder wall with lobulated margins, dimensions 20x16x23mm and lipid density (-100 - -130UH). The appearence of the bladder mass presented as a geometric figure which looked like a curved cordon (torus knot), a heterogeneous internal structure with few small 'dot-like' high attenuated central nodules. The walls of the urinary bladder were thick with increased contrast enhacement of the mucous- inflammatory pattern. The scanning took place at the15th and 20th min of excretory phase, first with the patient in supine position and second in prone position. During these 2 positions, the mass changed place (supine-anterolateral right, prone- posterior), which leaded us to the conclusions that this mass was a floating foreign body.

Discussion

The types of foreign bodies (FB) have been classified as inserted, migratory and iatrogenic [3]. Self-insertion of urethral FB is a common and objects are usually inserted via urethra for the purpose of eroticism, inquisitiveness and miscarriage or due to psychiatric illness, senility or alcoholism [1].
The variety of objects found self-inserted is impressive and include: sharp objects (eg, needles, lead pencils, copper wire, paper clips, pen-casings); tubes (eg, pieces of Foley
catheter, cable, rubber tube, Teflon® beak of resectoscope sheath); soft objects (eg, cotton swabs, tampons, carrot, surgical gauze); parts of animals (eg, bones); plants and vegetables (eg, hay, cucumber); fluids (eg, glue); powders (eg, cocaine); and others (eg, intrauterine devices) [2].
The aim of our study was to review its exact aetiology, to decide the method for retrieving and clinical presentation.
Usually, it is not difficult to diagnose foreign bodies in urinary bladder via CT imaging, but in this case due to the shape, aspect, structure and density we had some doubts. From the beginning it was thought to be a primitive tumour or peduncle tumour with a lipid component (fig. 1, 2, 3), but after images obtained in excretory phase at the 20th min we had no doubts that this was a foreign body (fig. 4). After long studies we thought it could be a clew of candle on account of curved cordon (torus knot), a heterogeneous internal structure with few small 'dot-like' high attenuated central nodules (fig. 5).
The most difficult issue was to collect the right anamnesis, because the boy was not sociable. We conversed with the parents and they were told about our suspect diagnosis and with the elder brother’s help the patient confessed that he had masturbated himself with a candle in his urethra.
The next day, the boy was admitted to hospital and surgery was performed. The diagnosis was confirmed post-operative.
With an experimental-demonstrative purpose, when we scanned (later) a cervico-thoracal region of another patient (fig. 6), we put a sample of a clew of candle nearby and we obtained the same images with the same properties of the mass, like we had observed at our patient.

Differential Diagnosis List

Final Diagnosis

Clew of candle in the urinary bladder. Cystitis.

URL:	https://www.eurorad.org/case/11426
DOI:	10.1594/EURORAD/CASE.11426
ISSN:	1563-4086