Infante Juan

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

Keywords:  trauma, bladder, pelvic anatomy

Leloutre Beatrice,  Boyer Corinne,  Leroux Carole,  Occelli Aurelie,  Guesmi Myriam,  Baqué Juston Marie

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

Authors:  Leloutre Beatrice , Boyer Corinne , Leroux Carole , Occelli Aurelie , Guesmi Myriam , Baqué Juston Marie

Keywords:  neurofibromatosis, bladder, new born

Shellikeri Sphoorti,  Back Susan,  Poznick Laura,  Darge Kassa

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

Authors:  Shellikeri Sphoorti , Back Susan , Poznick Laura , Darge Kassa

Keywords:  Ultrasound contrast, bladder phantom, contrast enhanced voiding urosonography

Gibson Samantha,  Koberlein George,  Neville Kucera Jennifer

Final Pr. ID: Poster #: EDU-038

This review aims to provide a comprehensive visual guide to the imaging features of fetal genitourinary obstructive anomalies. The development of the fetal genitourinary tract is a complex process and, in turn, there are a variety of points in time when the tract may be at risk for the development of malformations. Early diagnosis is crucial for optimizing prenatal care, preventing oligohydramnios, and improving the prognosis and management of affected neonates. Read More

Authors:  Gibson Samantha , Koberlein George , Neville Kucera Jennifer

Keywords:  Kidneys, Bladder, Congenital

Hodes Aaron,  Armenta Paul,  Levin Terry

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

Authors:  Hodes Aaron , Armenta Paul , Levin Terry

Keywords:  Urachus, Bladder, Umbilicus

Edwards Emily,  Zapala Matthew,  Copp Hillary,  Mackenzie John,  Phelps Andrew,  Courtier Jesse

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

Authors:  Edwards Emily , Zapala Matthew , Copp Hillary , Mackenzie John , Phelps Andrew , Courtier Jesse

Keywords:  Bladder

Kim Joseph,  Shukla Neal,  Hammer Matthew,  Lozano Richard,  Hajibeygi Ramtin,  Tu Long,  Rao Balaji

Final Pr. ID: Poster #: SCI-024

History:
A 14-year-old female was brought to the emergency department following a self-harm incident. During her assessment, she was found to have elevated blood pressures and a prolonged QTc interval. She reported frequent episodes of palpitations and dizziness over the past year, often occurring immediately after urination.

Findings:
Initial ultrasound showed unremarkable kidneys and normal hemodynamics in the renal vessels. However, a heterogeneously echogenic mass with increased vascularity on color Doppler was visualized in the left bladder wall. MRI confirmed that the mass originated from the bladder base and extended through the left bladder wall, showing avid contrast enhancement and restricted diffusion. Gallium-68 Dotatate PET/CT demonstrated intense radiotracer uptake in the bladder mass, left pelvic sidewall, and left internal iliac lymph nodes.

The patient underwent chemotherapy and partial cystectomy. Pathology revealed neuroendocrine and nested features with infiltration into the smooth muscle bundles consistent with the muscularis propria of the bladder. Tumor cells tested positive for chromogranin and synaptophysin immunostains, while pan-cytokeratin (AE1/AE3) was negative. Genetic testing identified the R242H variant in the SDHB gene.

Discussion:
Bladder paragangliomas are rare neuroendocrine tumors arising from the sympathetic paraganglia present in the bladder wall. They represent 6% of extra-adrenal paragangliomas and 0.05% of all bladder tumors. Typical symptoms include hypertension, hematuria, and catecholamine-associated symptoms like headaches and palpitations during micturition. Up to 63% of bladder paraganglioma patients have a germline mutation, most commonly in the SDHB subunit gene, increasing their risk of developing pheochromocytomas and additional paragangliomas. Therefore, lifelong biochemical and imaging screening from skull base to pelvis are recommended.

Conclusion:
Bladder paragangliomas are a rare variant of extra-adrenal pheochromocytomas. MRI plays an important role in the pretreatment diagnosis of bladder paraganglioma. Gallium-68 Dotatate PET/CT is highly specific and can help diagnose metastatic spread. Lifelong follow-up is recommended due to the risk of recurrence and metastasis, and the potential for developing additional paragangliomas or pheochromocytomas. Read More

Authors:  Kim Joseph , Shukla Neal , Hammer Matthew , Lozano Richard , Hajibeygi Ramtin , Tu Long , Rao Balaji

Keywords:  Bladder, PET/CT, Nuclear Medicine

Gokli Ami,  Barrera Christian,  Bellah Richard

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

Authors:  Gokli Ami , Barrera Christian , Bellah Richard

Keywords:  Bladder, Mass, Ultrasound

Nowariak Meagan,  Kruc Rebecca,  Ames Jeff,  Murati Michael,  Hoggard Eric,  Dietz Kelly

Final Pr. ID: Poster #: SCI-023

The purpose of our study is to determine the significance of bladder debris seen incidentally by ultrasound in pediatric patients undergoing outpatient non-emergent ultrasounds. Read More

Authors:  Nowariak Meagan , Kruc Rebecca , Ames Jeff , Murati Michael , Hoggard Eric , Dietz Kelly

Keywords:  Ultrasound, Bladder, Infection

Daghfal Megan,  Mitchell Craig,  Reid Churphena

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

Authors:  Daghfal Megan , Mitchell Craig , Reid Churphena

Keywords:  Urinary bladder, cyst