An unusual presentation of abdominal distension.

1 of 3 DESCRIPTION A middle-aged man presented with increased abdominal girth over 6–9 months, associated with pain in the right upper quadrant and fl anks. History was signifi cant for a non-seminomatous testicular cancer in his teens with left orchiectomy, aortic node dissection and 1 week of chemotherapy. On examination, the abdomen was grossly distended and non-tender, with positive fl uid wave and dullness to percussion. At an outside facility, laboratory values were within normal limits, including tumour markers, and ultrasound demonstrated what was believed to be a large amount of ascites and possible pancreatic mass. CT clarifi ed this as a slightly complex-appearing cystic mass fi lling the entire abdomen and pelvis. He underwent an aspiration of 5 litres, and cytology of the fl uid demonstrated spermatocytes. At our institution, MRI showed a markedly distended urinary bladder, measuring 29 × 26 × 12 cm ( fi gures 1 and 2 ). At cystoscopy, 7 litres of urine was drained and he has since initiated self-intermittent catheterisation. Urodynamic study with cystoscopy at 3-month follow-up showed an atonic and very fl oppy trabeculated bladder without any prostatic obstruction. A diagnosis of idiopathic neurogenic bladder has been made. Neurogenic bladder can be caused by any number of conditions that disrupt the coordinated interaction of motor and sensory inputs of both the autonomic and somatic Images in...