Ch. 42- Urinary bladder Flashcards
What are the most commonly involved structures in acquired or congenital fistulas?
rectum and vagina
What can you do (technique, radiograph acquisition, new views?) if you are suspicious that there may be uroltihs but you are not sure due to superimposition of soft tissue?
Do a compression view
Radiographic signs observed with UB disease include:
Irregular mucosal border, intramural thickening, filling defects, and leakage.
CT- excretory urography is helpful to dx what congenital condition?
ectopic ureters
What are some complications of cystography?
Mucosal ulceration, inflammation, granulomatous reactions (are transient)
Gas embolism (if doing a double contrast cystography)
What are the ligaments that hold the urinary bladder in place?
Ventral ligament of the UB (1)
Lateral ligaments of the UB (2)
What’s your most important radiographic interpretation?
The urinary bladder is distended with gas and contains radiopaque contrast material. The body and neck of the bladder are located within the pelvic canal.
Conclusion:
Abnormal positioning of the UB is consistent with a pelvic urinary bladder .
What is the best procedure (per Thrall) for identifying urinary bladder location, tears, hernias, and abnormal communication with adjacent structures?
Positive contrast cystography
What is your radiographic interpretation?
UB wall appears subjectively thickened
Multiple well-defined rounded variable in size filling defects outlined by the contrast medium (consistent with radioluscent uroliths)
What is your most likely dx?
TCC
What’s your ultrasonographic findings?
Multiple hyperechoic foci within the UB lumen consistent w/ debris (crystalline debris)
Attached filling defects may be cause by:
neoplasia, polyps, blood clots, adherent calculi, and ureteroceles
The urinary bladder is divided in three parts. What are they?
Apex- cranial
Body- middle
Neck- caudal
What is your dx?
a UB diverticulum. In this case it was due to a post traumatic effect
What’s your main CT image finding?
ureter inserts at the level of the neck of the UB= ectopic ureter
What are some causes for UB wall thickening?
fibrous tissue proliferation or cellular infiltration from inflammation (cystitis)m hemorrhage or neoplasia
What’s you dx?
A large hyperechoic structure creating acoustic shadowing consistent w/ calculi
There is also irregular thickening of the craioventral UB wall
What is the normal UB wall thickeness ?
1mm regardless of the degree of distention
Normal urinary bladder wall thickness varies depending on the degree of urinary bladder distention and body weight, being 2.3 mm thick with minimal distention and 1.4 mm thick with moderate distention.57 In normal adult cats, the mean urinary bladder wall thickness should not exceed 1.7 mm ± 0.6 mm
What is the most common site for TCCs to be located?
Neck of UB
What is your sonographic finding?
Mildly dilated anaechoic ureter adjacent to the urinary bladder neck. The dilated ureter coursed past the ureterovesicular junction and continued past the urinary bladder, indicating ectopic ureter
What is your main CT image finding?
heterogeneous irregularly marginated hyperattenuating material within the UB wall= UB mass
What’s your dx? With what endocrine disease is this commonly seen?
Emphysematous cystitis.
This is commonly seen in diabetic patients.
Which cystics calculi are radiopaque? What about radioluscent?
radiopaque: calcium oxalate or phosphate, struvite, silica
radioluscent: urate, cystine
What is the cobra-head sign?
when ureteroceles communicate partially with the UB and fill with positive-contrast medium or they may not communicate and create a negative filling defect
What’s your dx?
Polypoid cystitis
Often located in the cranioventral and craniodorsal portions of the UB wall
What are some common causes of free filling defects?
gas bubbles, calculi, blood clots
What’s your dx?
There are multiple linear hyperechogenicities. Some have reverberation artifact some don’t. This is consistent w/ emphysematous cystitis.
What’s your radiographic finding of this post double ocntrast cystography?
Mild mucosal irregularity of the wall of the UB at the level of the apex.
You can see these changes with chronic cystitis
What procedure is best for assesing UB wall lesions and intraluminal filling defects?
A double contrast cystography
How do smooth muscle neoplasia appear on ultrasound?
As a single, round, well-defined intraluminal mass
What is the best technique to assess leakage of urine from the UB?
retrograde positive-contrast cystography
with small UB neck tears, leakage contrast medium may be slow with only a small volume appearing outside the UB. In these instances, a 2nd rad may be required around 5-10 min post inj
Where are urinary bladder fibrosarcomas and rhabdomyosarcomas are often located?
the neck of the UB and are typically found in young dogs
What is your dx? This is a male dog.
Uterus musculinus
Uterus masculinus (persistent Mullerian duct) is a vestigial embryological remnant of the paramesonephric duct system in males and has been associated with clinical signs such as dysuria, incontinence, tenesmus and urethral obstruction in dogs.
Uterus masculinus appeared as single (four dogs) or two (two dogs)horn-like, tubular (fourdogs) or cylindrical (two dogs) structures, originating from the craniodorsal aspect of the prostate gland and
extending cranially.
Both negative- and positive-contrast media can be used for cystography. Negative contrast media include:_______. What about positive contrast media?
negative media: room air, CO2, nitrous oxide
positive media: water soluble organic iodines. Never use barium for cystography
