Multiple hemangiomas of the urinary bladder in a child with gross hematuria

Abstract

We report a case of multiple hemangiomas involving the urinary bladder in a 4-year-old boy who presented with recurrent episodes of gross hematuria. On ultrasonography, compared with the bladder wall, the lesions presented as multiple isoechoic polypoid intraluminal masses with mildly increased vascularity on color Doppler exam. Cavernous hemangioma was confirmed by cold-cup biopsy, and the all lesions were coagulated with a Holmium laser. Despite their rarity, bladder hemangiomas should be included in the differential diagnosis of multiple intravesical masses in children with gross hematuria.

Keywords: Child, preschool; Hemangioma; Ultrasonography; Urinary bladder.

Fig. 1.. A 4-year-old boy with recurrent gross hematuria due to multiple bladder hemangiomas.

A. Pelvic ultrasonography with a high-frequency linear transducer reveals multifocal intraluminal polypoid masses (arrows) in the urinary bladder, which are isoechoic compared to the bladder wall and well-defined, without definite intramuscular involvement or perivesical extension; no definite bladder wall thickening or prominent trabeculation is visible. B. On color Doppler ultrasonography, the masses have focal mild internal vascularity in the mid portion of the lesion, probably from the feeding vessel. C. Pelvic computed tomography with contrast enhancement demonstrates an enhancing mass (arrow) on the bladder wall with intraluminal protrusion and no perivesical invasion. D. A cystoscopic image obtained during surgery reveals reddish sessile lesions suggestive of bladder hemangiomas. E. A biopsied specimen of the bladder dome lesion shows large cystically dilated vascular channels lined by endothelial cells in the submucosa, suggesting a diagnosis of cavernous hemangioma (H&E, ×100).