Final Pr. ID: Poster #: CR-014
Urinary bladder injuries are classified based on intraperitoneal versus extraperitoneal location. Intraperitoneal lacerations are associated with a higher risk of sepsis and tend to be large and are therefore treated with prompt surgical exploration and repair. In contrast, extraperitoneal bladder ruptures are commonly managed conservatively via simple catheter drainage with healing commonly achieved between 10 days and 3 weeks. However, lower urinary tract injuries are an exception to the rule which also require emergent intervention.
The subject of this case report is an 8-year old girl that suffered lacerations to the bladder neck, bladder trigone, and pelvic floor during a motor vehicle collision. The initial contrast-enhanced phase demonstrated bladder wall thickening and intraluminal blood clot. Bladder rupture was not directly apparent until the patient was called back for a delayed scan of the pelvis which showed contrast extravasation from the trigone pooling around retroperitoneal spaces including the mesorectal fascia surrounding the rectum and the presacral space. Although these are not intraperitoneal locations, the radiologist should be aware that lacerations involving the bladder neck and lower urinary tract warrant immediate surgical consultation.
Lower urinary tract injuries are sufficiently uncommon that an experienced urologist may encounter only a handful during their career. This case report highlights the anatomic spaces in the pelvis that are necessary to troubleshoot the likely location of a bladder injury and that the lack of intraperitoneal pooling of contrast should not distract from the emergent nature of this rare injury. The common association of lower urinary tract injury with pelvic floor disruption is also highlighted in this case as the patient had lacerations and pooling of contrast extending along the vagina and into the labia. Finally, the importance of delayed excretory phase imaging in the setting of pelvic trauma is emphasized to allow for the prompt diagnosis of bladder trauma. Read More
Authors: Infante Juan
Final Pr. ID: Poster #: CR-01 (R)
Objective: to report an unsual presentation of neurofibromatosis involving the genito-urinary tract. Bladder involvement was the initial presentation of a Von Recklinghausen disease in a new born for whom the family disease was initially unknown by the medical staff. Read More
Final Pr. ID: Poster #: EDU-050
ceVUS is a radiation-free and sensitive examination to detect vesicoureteral reflux and image the urethra in children using ultrasound (US) and intravesical administration of an ultrasound contrast agent (UCA). Due to the growing interest to perform ceVUS in children, a urinary bladder phantom was developed to teach the technical aspects of the ceVUS examination. Here we describe the preparation and utility of this reusable phantom as a tool to simulate the UCA administration, distribution and the effect of different US parameters on the UCA appearance in the bladder. Read More
Final Pr. ID: Poster #: EDU-018
Urachal remnants include patent urachus, urachal cyst, urachal sinus and urachal diverticulum. Clinical presentation is variable depending on the type of urachal remnant and the patient’s age. Infants with a patent urachus often present with persistent umbilical discharge or granuloma, while older patients may present with urinary tract infection, or inflammation of the urachal remnant mimicking appendicitis or other intraabdominal inflammatory process. Urachal remnants may also be incidental or may be associated with an existing syndrome such as Eagle Barrett Syndrome. In this presentation, to understand the derivation of the different types of urachal remnants, the embryologic development of the urachus and its relationship to the bladder and allantois is reviewed. Diagnostic ultrasonographic, fluoroscopic and CT images in patients with different types of urachal remnants are shown. Additionally, an unusual case of bladder prolapse presenting as an umbilical mass in a newborn with a patent urachus is presented. Read More
Final Pr. ID: Poster #: EDU-061
Bladder masses are periodically encountered in the pediatric population, yet there are few resources to guide appropriate imaging assessment of pediatric bladder masses. A pediatric bladder mass may be encountered in a wide variety of clinical settings, ranging from investigation of a specific symptom or laboratory abnormality to an incidental finding during routine evaluation. Familiarity with the spectrum of benign and neoplastic processes that may give rise to pediatric bladder masses increases the likelihood of timely and accurate diagnosis and management. Read More
Final Pr. ID: Poster #: EDU-045
The complete ultrasound (US) evaluation of the urinary tract in a pediatric patient should include both the urinary bladder and kidneys. Evaluation of the bladder as part of that overall US examination, however, can be deemphasized or incomplete due a number of factors, such as one’s neglecting to fully image the bladder from dome to bladder neck, suboptimal bladder distension, incomplete distension due to presence of an indwelling drainage catheter or vesicostomy, or in some instances, because the bladder is not included as part of the routine kidney ultrasound exam. True masses arising from the urinary bladder in children are generally rare, and at times, subtle and non-specific, and potentially mimicked by so-called pseudomasses, so we emphasize that correlation of findings with patient history is of paramount importance.
This pictorial review will illustrate and describe the US appearances (along with selective cross-sectional imaging), clinical manifestations, and tumor growth patterns of common and uncommon conditions arising from the pediatric urinary bladder, i.e. path-proven masses that include leiomyosarcoma, pheochromocytoma, nephrogenic adenoma, vascular malformation, low grade urothelial neoplasms, neurofibromatosis, fibroepithelial polyps, rhabdoid tumor, and rhabdomyosarcoma. Pseudomasses of the bladder that will also be illustrated and briefly discussed include hematomas, urachal remnants, complex ureteroceles, Deflux injection sites, foreign bodies, and cystitis (viral, eosinophilic, parasitic). In addition to emphasizing the importance of the complete bladder examination, the purpose of this review is to increase radiologist’s awareness of the US appearances of the common and uncommon conditions which afflict the pediatric urinary bladder, as well as those conditions that can mimic bladder masses, in order to determine proper clinical management. Read More
Final Pr. ID: Poster #: CR-031
We report the case of a previously unreported subserosal cyst of the urinary bladder in a male neonate. Prenatal sonography revealed a cystic structure in the fetal bladder that was presumed to be a ureterocele. Renal and bladder sonography at 11 days-of-age revealed a 9mm thin-walled simple cyst within a decompressed urinary bladder. The kidneys were sonographically normal. A VCUG performed the same day revealed an ovoid-shaped filling defect along the posterior-superior bladder wall. The bladder was otherwise normal. There was no vesicoureteral reflux, but a prostatic utricle filled with contrast. Cystoscopy performed at 3 months of age revealed single ureteral orifices bilaterally and no ureterocele. A dome-like lesion measuring approximately 1 cm in size was visualized along the posterior bladder wall. Sonography of the bladder performed earlier on the same day as cystoscopy once again revealed a thin-walled anechoic cyst within the posterior bladder wall. At 7 months of age, the infant underwent cystoscopic surgical excision of the bladder lesion as well as orchiopexy for an undescended testicle. The results of histopathologic analysis revealed a benign subserosal cyst with an epithelial lining and an entrapped duct. A review of the literature revealed only two previously reported cases of subserosal bladder cyst, both in adults. The natural history of these cysts is unknown. However, given the benign sonographic and histopathologic appearance of these lesions, we propose that these cysts can be safely followed with interval sonography. Read More