A 70-year-old woman was admitted to the hospital with flash pulmonary edema and severe hypertension after voiding. She noticed the progressive symptoms of palpitation, sweating and headache after voiding for 4 months and a palpable suprapubic mass. Her blood pressure was 110/70 mm Hg but after voiding increased to 200/120 mm Hg. Results from other physical examinations were unremarkable except for a soft tissue mass discovered at the suprapubic region which had a diameter of 3 cm. Bladder paraganglioma was confirmed by elevated 24-hour urine metanephrine and normetanephrine, 48.9 μg (normal level, 52–341) and 589 μg (normal level, 88–444), respectively. MRI revealed a 7.4 cm × 8 cm × 7 cm lobulated mass at the postero-superior aspect of the urinary bladder with a hypersignal on T2W1 (Figure 1), which was compatible with findings from I-131-metaiodobenzylguanidine with SPECT/CT. Anterior pelvic exenteration with ileal conduit was performed without any complications.