Question

What is the diagnosis based on the following X-ray?

• A. Uterine Fibroid
• B. Bladder Carcinoma
• C. Bladder stone
• D. Renal Tuberculosis

Hint:

Multiple oval radiopaque densities centrally in the pelvis suggest stones in which organ?

Answer 1

The Correct Option is C

Step 1: The X-ray shows multiple bladder calculi: several oval radiopaque densities lying centrally in the pelvis, the classic location and appearance of bladder stones. Most bladder calculi are round or oval, though they may be amorphous, laminated, or spiculated (jackstone).
Step 2: Bladder calculi may form from infection, especially with Proteus in a poorly functioning bladder, in which case the stones are magnesium ammonium phosphate and apatite (struvite). They may be asymptomatic or present with haematuria, suprapubic pain, disruption of the urinary stream, or recurrent infection.
Step 3: Why the distractors are wrong: a uterine fibroid calcifies in a coarse, popcorn or whorled pattern arising from the uterus, not as discrete oval pelvic-floor radiodensities. Bladder carcinoma is a soft-tissue mass that is not radiopaque on plain film. Renal tuberculosis produces upper-tract calcification, autonephrectomy or a putty kidney, not central oval vesical stones.
Step 4: Ultrasound confirms bladder stones as highly echogenic mobile foci, and on contrast studies they appear as filling defects. The diagnosis is bladder stone.