Ch 11 Bladder and urethra

Question 1

What is the best condition for obtaining images of the bladder during ultrasound?

Answer 1

Moderately distended

If the bladder is empty, it is advisable to rescan after natural filling or using a urinary catheter.

Question 2

What artifact can occur due to air within the colon during bladder ultrasound?

Answer 2

Mirror-image artifact

This artifact is caused by errors in the position of echoes reflected from the ventral colon wall.

Question 3

What are the four histological layers of the bladder wall?

Answer 3

• Mucosa (hypoechoic)
• Submucosa (hyperechoic)
• Muscularis (hypoechoic)
• Serosa (hyperechoic)

These layers are difficult to define sonographically compared with the gastrointestinal tract.

Question 4

What causes ureteral jets to appear on ultrasound?

Answer 4

Difference in specific gravity between urine in. the bladder and urine exiting the ureter

Question 5

Answer 5

Mirror-image artifact in a dog, caused by errors in position of echoes reflected from the colonic wall–gas interface

Question 6

What is the preferred modality for assessing the entire urethra?

Answer 6

Retrograde positive-contrast urethrography

Ultrasound is a useful complementary modality for part of the accessible urethra.

Question 7

What is the typical ultrasound appearance of cystitis?

Answer 7

Extensive irregular hypoechoic thickening of the urinary bladder wall

This thickening is usually greatest at the cranioventral aspect of the bladder.

Question 8

What type of cystitis is associated with gas-forming bacteria?

Answer 8

Emphysematous cystitis

Seen most commonly in diabetic animals with glucosuria.

Question 9

Fill in the blank: The normal range of bladder wall thickness in cats has been reported to be up to _______.

Answer 9

1.7 mm

This is based on findings from Finn-Bodner in 1995.

Question 10

What can cause urinary bladder outflow obstruction in cases of cystitis?

Answer 10

Detached necrotic tags and debris

These features are associated with pseudomembranous cystitis.

Question 11

What artifact can appear on ultrasound images of the urinary bladder?

Answer 11

Pseudosludge

Caused by side-lobe and grating-lobe artifacts.

Question 12

What ultrasound technique can help reduce the formation of confusing echoes?

Answer 12

Spatial compounding

(images: The time gain compensation has been adjusted to reduce the appearance of the pseudosludge artifact. The use of
spatial compounding will also help reduce this artifact.)

Adjustment of gain and harmonic ultrasound can also help.

Question 13

Bladder wall inversion is a temporary condition i.e. it can return to normal - true or false?

Answer 13

True. It is associated with cystitis in dogs and cats, and can be encountered as a temporary event following long-term catheterisation.

Question 14

What is this condition called?

Answer 14

Bladder wall inversion

Question 15

What is the most common neoplasm of the urinary bladder?

Answer 15

Transitional cell carcinoma (TCC).

Question 16

Describe the appearance of transitional cell carcinoma (TCC) on ultrasound.

Answer 16

An irregular bladder wall mass with a broad-based attachment, often poorly to moderately echogenic, and may be partly mineralized.

Question 17

What are the most common urethral neoplasia?

Answer 17

TCC, SCC, adenocarcinoma

Question 18

How does high-frequency bladder ultrasound compare to radiographic contrast procedures in calculi detection?

Answer 18

It has a similar accuracy but tends to overestimate true cystolith size.

Question 19

Where does u-bladder TCC commonly extend? What are possible consequences of TCC?

Answer 19

It is common for the mass to extend into the proximal urethra. Also since it is commonly in the trigone, it can occlude the UVJ and cause hydroureter/obstruction.

Question 20

What is the twinkle artifact and its significance?

Answer 20

A zone of rapidly flashing red and blue color signals distal to a highly reflective structure, indicating mineral calculi or sediment.

Question 21

Which type of tumour is most commonly associated with the distal urethra

Answer 21

SCC

Question 22

Answer 22

TCC

Question 23

A distal shadow is only variably present and is more likely seen with a higher/lower transducer frequency.

Answer 23

higher

Question 24

True or False: Bladder tumors can diffusely invade the bladder wall.

Answer 24

True (image: diffuse carcinomatous infiltration)

Question 25

2 different dogs; Tumor type? is it more likely epithelial or mesenchymal?

Answer 25

mesenchymal - smooth muscle tumors. left: low-grade leiomyosarcoma right: leiomyoma

Question 26

What is this image showing?

Answer 26

Twinkle artifact with calculi. Using color flow Doppler, an area of rapidly flashing colored signals is displayed when encountering mineralized structures. ## Footnote The colon appears as a linear interface in the longitudinal plane.

Question 27

Is this pseudosludge/side-lobe artifact or pyuria?

Answer 27

Pyuria appears as non-shadowing, moderately echogenic sludge that progressively sediments during the exam. A straight horizontal border is seen (arrow). It should not be confused with a side-lobe artifact. ## Footnote Mobility of intraluminal structures can also be demonstrated with patient repositioning.

Question 28

Name some congenital urinary bladder / ureteral abnormalities that may be identified sonographically.

Answer 28

* Urachal diverticulum * Patent urachus * Urachal cysts * Ureteroceles * Ectopic ureters ## Footnote These anomalies may predispose to incontinence or urinary tract infections.

Question 29

What are ureteroceles?

Answer 29

Cystic dilations of the terminal ureter within the urinary bladder ## Footnote They can be orthotopic or ectopic based on ureter entry location.

Question 30

What characterizes a vesicourachal diverticulum?

Answer 30

Fluid-filled structure extending as a convex out-pouching of the bladder lumen ## Footnote Typically has a thin wall, which can thicken in chronic cystitis cases.

Question 31

What is the preferred method for diagnosing rupture of the urinary bladder?

Answer 31

Positive-contrast retrograde cystourethrogram ## Footnote Ultrasound can show thickened bladder walls and abdominal effusion.

Question 32

What artifact can mimic bladder wall rupture on ultrasound?

Answer 32

Refraction artifact ## Footnote This artifact appears at the cranial aspect of the bladder when abdominal effusion is present.

Question 33

What types of foreign bodies can be found in the bladder lumen?

Answer 33

* Grass awn * Parts of catheters ## Footnote These can lead to complications in bladder function.

Question 34

Same condition in 2 dogs - what is it?

Answer 34

polypoid cystitis

Question 35

Which species gets polypoid cystitis?

Answer 35

dogs

Question 36

What is the most common location of polypoid cystitis?

Answer 36

cranioventral aspect of the urinary bladder could also be craniodorsal

Question 37

Which type of patients are associated with emphysematous cystitis?

Answer 37

diabetics with glucosuria | add the canadian paper later

Question 38

Which urinary bladder changes occur with pseudomembranous cystitis?

Answer 38

characterised by ulceration, necrosis and haemorrhage of the wall, with intraluminal debris (necrotic, fibrinous, haemorrhagic). This causes sloughing of the mucosa with fibrin strands (see image), which can mineralise. ## Footnote It was observed in a study involving multiple dogs.

Question 39

What changes would Histoplasma capsulatum cause in the bladder?

Answer 39

Granulomatous cystitis (fungal), diffuse hyperechoic wall thickening ## Footnote https://pubmed.ncbi.nlm.nih.gov/22474050/ no access to paper

Question 40

Point out the corpus spongiosum, corpous cavernosum, and tunica albuginea

Answer 40

Question 41

The left is B mode; what is on the right?

Answer 41

Harmonicultrasound reduces both the near-field and the far-field artifacts.

Question 42

urinary bladder mass lesion - benign, malignant or can't tell from the image?

Answer 42

At necropsy, the urinary bladder mass was a hematoma secondary to renal hemangiosarcoma (image).

Question 43

Congenital urinary bladder abnormalities may predispose patients to ______________ or ______________, or may be incidental findings.

Answer 43

incontinence UTIs

Question 44

Vesicourachal diverticuli are typically in the ___________ aspect of the urinary bladder wall.

Answer 44

cranioventral

Question 45

Answer 45

This refraction artifact at the cranial aspect of the blad- der mimics bladder wall rupture (arrow), but no bladderwall ruptureispresent. The artifact occurs at the cranial aspect of the urinary bladder when abdominal effusion is present. The interpretation of the artifact is aided by a concurrent edge shadow and absence of bladder wall thickening.

Question 46

Answer 46

urachal diverticulum in a cat

Question 47

Answer 47

urachal diverticulum in a cat, depression filled with sediment in the cranioventral bladder