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© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Bladder cancer, gadolinium MRI None declared.

Patient Consent: Obtained.

Received on September 20, 2021 
Accepted on September 27, 2021

Soc Int Urol J.2021;3(1):48

DOI: 10.48083/OFWX4645

[james.kovacic@health.nsw.gov.au]

Gadolinium Contrast in the Bladder:  
A Malignant Mimic
James Kovacic, Jonathan Kam, Edward Latif

In affiliation with the Division of Surgery and Anaesthesia, Department of Urology, Gosford District Hospital

A 50-year-old female presented to hospital with diplopia and unsteady gait. The patient was identified to have a 
disconjugate gaze palsy involving the right medial rectus muscle. Investigation for an ischaemic event proved negative, 
with an unremarkable MRI of the brain. A paraneoplastic screen, including a CT of the chest, abdomen, and pelvis, 
was undertaken to identify an alternative cause for her symptoms.

An incidental finding of a large, enhancing bladder mass was identified on CT imaging (Figures 1 and 2). The 
bladder mass was hyperdense arising from the anterior bladder wall and had an atypical serpiginous appearance. 
There was no hydroureteronephrosis. Differentials included a bladder lesion or, less likely, an organised haematoma. 
The patient had a significant smoking history but no prior haematuria. Urine cytology was negative, and a renal tract 
ultrasound failed to identify the lesion.

Flexible cystoscopy was performed, demonstrating a normal appearing bladder. Further discussion with the radiol-
ogists identified that the gadolinium contrast given for her MRI scan 2 hours before the CT scan was likely layering 
within the bladder, masquerading as a bladder lesion.

Acknowledgements
The authors wish to thank the Gosford District Hospital staff involved with this case.

FIGURE 1. FIGURE 2.

48 SIUJ  •  Volume 3, Number 1  •  January 2022 SIUJ.ORG

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