CASE 18725 Published on 08.10.2024

Hyperechoic mobile structure in the bladder

Section

Uroradiology & genital male imaging

Case Type

Clinical Case

Authors

Ratsimbasoa Ny Ako 1, Rajaonarison Lova Hasina Ny Ony Narindra 1, Andriamihajatiana Rindraniaina 1, Ranoharison Hasina Dina 2, Ahmad Ahmad 1

1 Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (CHUJRA), Antananarivo, Madagascar

2 Centre Hospitalier Universitaire Andohatapenaka (CHUA), Antananarivo, Madagascar

Patient

60 years, male

Categories
Area of Interest Urinary Tract / Bladder ; Imaging Technique Ultrasound
Clinical History

A 60-year-old man living in a rural area presented with gross haematuria and a gradually increasing painful urination for one month.

Imaging Findings

A kidney and bladder ultrasound was performed at our institution, which showed a mobile hyperechoic structure in the bladder, measuring 6 cm in transverse diameter and 7 mm in thickness, and associated with some layering debris. Mild bladder wall thickening was also noted (Figure 1).

There was an enlargement of the prostate with a mild intravesical protrusion (Figure 2). There was no renal mass, and a mild calyceal dilatation was noted (Figure 3).

Discussion

Urinary bladder is a rare localisation for an Ascaris to be found; usually, it is located in the gallbladder and the intestines [1]. Cystoscopic findings of an urinary bladder localisation have been reported in the literature, but there are actually no reports of a live worm found in the bladder during an ultrasound examination.

Ascaris worms migrate into the urinary tract either through fistulisation through the digestive system or through urethral retrograde migration [1]. In our case, given that there were no digestive symptoms and the recent onset of symptoms, we could suggest that it was through urethral migration.

The typical clinical presentation is haematuria and painful urination.

The imaging findings which were suggestive of a live Ascaris in the urinary bladder were the shape, which is curvilinear, and the serpentine movements during live sonography. The mild calyceal dilatation is supposedly due to the enlargement of the prostate.

No additional examination was performed, and conservative treatment was pursued. A week later, the patient expelled the worm through urination.

Live Ascaris in the bladder has the same sonographic characteristics as those found in the gallbladder and the intestines: a mobile curvilinear hyperechoic structure.

All patient data has been completely anonymised throughout the entire manuscript and related files.

Differential Diagnosis List
Bladder lithiasis
Foreign bodies
Ascaris worm
Mass
Blood clots
Pus
Final Diagnosis
Ascaris worm
Case information
URL: https://www.eurorad.org/case/18725
DOI: 10.35100/eurorad/case.18725
ISSN: 1563-4086
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