Unusual Computed Tomographic features of Bladder Cancer with Giant bladder stone and pulmonary metastasis: A case report

Abstract

Bladder cancer is the most common urothelial malignancy and is frequently linked to chronic bladder irritation from calculi and recurrent infections. Although associations between bladder stones and malignancy have been described, the coexistence of bladder cancer, large bladder, and renal calculi with lung metastasis is extremely rare. A 58-year-old man presented to the emergency department with acute urinary retention. Laboratory findings demonstrated markedly elevated serum urea and creatinine. Kidney–ureter–bladder (KUB) radiograph revealed a giant vesical calculus measuring 10 × 8 cm. Computed Tomography (CT) urography confirmed multiple bilateral renal calculi and a large bladder stone, along with diffuse anterior and lateral bladder wall thickening and a polypoid mass on the right lateral wall extending into the bladder lumen, nearly obliterating it, with paravesical extension. CT chest revealed multiple “cannonball” pulmonary metastases. The patient underwent open cystolithotomy with bladder biopsy, which confirmed an undifferentiated bladder carcinoma. This case demonstrates an unusual presentation of bladder cancer with concurrent large bladder and renal stones and distant pulmonary metastases. The coexistence of these findings has not, to our knowledge, been previously reported in English literature. Chronic irritation from calculi and infection likely contributed to malignant transformation. Bladder cancer should be considered in patients with long-standing urinary symptoms, recurrent urinary tract infections, or hematuria in the presence of bladder calculi. Computed Tomography is highly sensitive for detecting urinary tract calculi. Early diagnosis is crucial to guide timely intervention and improve outcomes.