 Good morning friends, sharing a very interesting case which made me speculate that how it is important to follow up what cases we give on ultrasound to know what is the outcome of each and every case. So it stresses the importance of taking follow up in our day to day clinical practice. This was a 15 year old chronic smoker who presented for ultrasound with massive painless hematuria. I did this ultrasound where I saw his left kidney was normal but the right kidney showed mild hydrolytonephrosis. But what was surprising was a large bladder clot with a posterolateral thickening involving the right vasocurator junction. Now seeing these kind of findings his prostate was also normal, I strongly suspected that in a smoker this could be underlying neoplastic etiology like a transitional cell carcinoma. He was known to me and therefore I asked for the CT abdomen which confirmed our ultrasound findings and even Dave said that the possibility of neoplasm needs to be ruled out. Patient went to the urologist and scistoscopy with bladder clot removal was done and they took multiple biopsies of that area of that posterolateral thickening and they also suspected that this looks malignancy. But the histopath was a game changer in this case. The first HP look reported that there seems no malignant cells but some atypical cells and they asked therefore an immunohistocytochemistry and a second opinion HP was done. The histopathologist's second time when she looked at the slide she strongly suspected that this looks to be granulomatocystitis and therefore she said possibility of cox to be ruled out. So patient came back to the clinician where then they took an opinion of a chest physician where the chest physician asked was asking for a PET CT and a urine TB PCR gene and low behold the urine TB PCR actually came positive for mycobacterium tuberculosis. So stressing the importance that in day to day practice if you follow up your cases it's a great learning curve and the case is mainly to present geocops which is so rarely seen in today's era. Thank you.