A 69-year-old female presented to the ED as a transfer from an outside hospital (OSH) after falling down 15 stairs and sustaining a small subdural hematoma. She reported that she slipped at the top of the stairs and ended up at the bottom. She thought she had brief loss of consciousness. She was not on any blood thinners, aspirin, or clopidogrel. At the OSH, a CT scan of her head and c-spine were obtained, but there was no other imaging performed.
Initial vital signs were within normal limits.
Physical exam revealed a woman lying back in bed, alert and oriented x3 with her eyes closed. She had TTP in the mid-thoracic spine. She had mild tenderness over her abdomen without rebound or guarding.
As part of the trauma work-up, a FAST exam was performed.
Here is the RUQ view:
There is no free fluid seen in this view.
Here is a view of the pelvis:
That bladder looks huge! Or is that the bladder?
Here is another clip of the pelvis:
Still think the bladder is huge? In this image you can see the bladder on the right side of the screen with an anechoic mass in front of the bladder.
Here is a still:
Here is another still of the mass with measurements taken:
The rest of the FAST exam was negative for free fluid.
The patient was taken for a CT of her chest, abdomen, and pelvis given the mechanism and the midline tenderness in her thoracic spine.
Here are a few images from her CT scan:
The impressively large mass is seen in these images.
Radiology felt like this probably represented an adnexal mass of unknown significance, but malignancy could not be ruled out. There were no other abnormal findings on the CT scans.
From a trauma standpoint, the patient did well and was discharged to subacute rehab on hospital day 5. She was to follow-up at the regional tertiary referral center for the adnexal mass.
Bottom Line: Not every anechoic structure in the pelvis is the bladder!
