77 year old male presents to the ED with painless hematuria. A routine CT scan performed, shows a filling defect in the urinary bladder, with a linear calcification. Now is that a mass?
Spectral to the rescue! The filling defect shows no iodine uptake, and is increased density on virtual non-contrast image. The spectral curve is flat, consistent with lack of iodine uptake. This is a bladder clot.
My super-smart resident does a prone image and the filling defect is clearly mobile, confirming what spectral told us.