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.
SPR 2018 Annual Meeting & Postgraduate Course