case_images: PMC9635272_01
case_images: Cystoscopy shows a suspected PVF at the 12 o'clock position of the bladder neck, close to the center of the eroded pubic symphysis (a and b).
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case_images: After a cystoscopy and cystography showing a suspected PVF at the 12 o'clock position of the bladder neck, close to the center of the eroded pubic symphysis, without any evidence of contrast medium spillage (Figure 1), a suprapubic catheter was placed.
case_images: MRI of the pelvis confirming the presence of pubovesical fistula. Axial (a) and sagittal (b) images.
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case_images: An abdominal magnetic resonance imaging (MRI) confirmed the presence of the fistula with marked edema of the surrounding soft tissues, which mainly involved the medial sectors of the external obturator muscles and the anterior portion of the internal obturators; considerable edema also involved the spongy bone of both pubic branches (Figure 2).
case_images: Choline PET-CT detects a left external iliac lymphadenopathy and a further capture of the tracer at the level of other left external iliac lymph nodes and inguinal lymph nodes bilaterally (a). Choline PET-CT performed after cystectomy and lymphadenectomy where previously highlighted lymphadenopathies are no longer visible (b).
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case_images: In addition, PET/CT showed a "ribbon-like activity" stretching from the anterior region of the bladder to the pubic symphysis consistent with the fistulous conduit (Figure 3).