42 - Urinary Bladder

Question 1

Name the layers of the urinary bladder wall

Answer 1

Mucosa, submucosa and muscular. Serosal layer formed by reflection of peritoneum?

On US, can see Muc, Musc, and serosa. (hyper, hypo, hyper)

Question 2

In what % of dogs with perineal hernia has urinary bladder retroflexion been reported?

Answer 2

24%

Question 3

What feature of the urinary bladder has been associated with other urogenital congenital abnormalities?

Answer 3

Intrapelvic location

Question 4

What radiographic features may be observed with persistent urachal ligament?

Answer 4

Pointed apex, elongated UB

Question 5

Which pathology has been associated with emphysematous cystitis?

Answer 5

Diabetes mellitus -> glucose fermenting organisms

Question 6

Which tests (x3) should be used to evaluate dynamic urinary bladder disease (e.g. urethral incompetence, urinary incontinence)?

Answer 6

Voiding cystography, cystometry and urethral pressure profiles

Question 7

List 5 complications of cystography

Answer 7

Trauma

Bacterial contamination

Knotting catheter

Air embolus

Submucosal / serosal contrast accumulation (cats typically, usually fine, can lead to ulceration, inflammation and granulomatous reaction)

Question 8

Which gases should be used to avoid air embolus?

Answer 8

Nitrous oxide, carbon dioxide

Question 9

What is the recommended range of volume for contrast in cystography?

Answer 9

3.5-13.1ml per kg (10ml/kg average)

Question 10

List 6 urinary stones and the associated radiographic characteristics reported

Answer 10

Question 11

What volume of undiluted contrast should be administered in a double contrast study in the cat and dog?

What is double better for?

Answer 11

Cat: 0.5-1ml

Dog: 1-6ml

Urinary bladder wall lesions, and filling defects

Question 12

What is the normal thickness of urinary bladder wall regardless of distension?

Answer 12

Approx. 1mm.

Question 13

LEARN table of radiographic characteristics of urinary bladder pathologies…

Answer 13

Question 14

What creates the “cobra-head” sign?

Answer 14

Ureterocoele which communicates with bladder lumen, and takes up contrast

Question 15

List 3 different urachal abnormalities

Answer 15

Diverticulum (acquired, congenital),

Cyst,

Peristent urachus / urachal ligament

Question 16

LEARN 5 types of urinary bladder defects….

Answer 16

Question 17

List 2 pitfalls of cystographic interpretation

Answer 17

1) Air bubbles
- small -> calculi
- Large -> bladder wall thickening
- Multiple -> honeycombing
2) Pseudofilling defect
- Incomplete filling and external compression

Question 18

What is the US thickness of the normal urinary bladder wall in cats and dogs?

Answer 18

Cats: <1.7mm

Dogs 1.4-2.3mm (depending on distension and BW)

Question 19

Name 3 physics based artefacts in the urinary bladder!

Answer 19

Reverberation in near filed

Side / grating lobes ( echogenic appearance near bladder wall, due to e.g. colon interference)

Question 20

Name 3 causes of lacy echoes within the urinary bladder than are not significantly effected by ballotement

Answer 20

Acute haemorrhage

Lipid

Severe proteinuria

Question 21

Acoustic shadowing is related to two features when observing calculi. What are they, and how do they effect shadowing?

Which artefact may be used to help identify calculi?

Answer 21

Calculus height (taller, more shadowing)

Freq (higher freq., more shadowing)

**Shadowing and echogenicity independent of chemical composition**

Twinkling artefact -> distal to calculus using colour doppler

Question 22

What ultrasonographic technique may help identiify bladder rupture?

Answer 22

Infusion of microbubbled saline

Question 23

Describe features of US features of polypoid cystitis

Answer 23

Cranioventral OR craniodorsal location

Pedunculated, ovoid or nodular wall changes

Question 24

Describe US features of emphysematous cystitis

Answer 24

Linear hyperechogenicities within the bladder wall / lumen +- reverberation

Question 25

Describe US features of urethral obstruction

Answer 25

Bladder wall thickening,

Echogenic urine sediment / increased echoes

Pericystic fluid / steatitis

Upper urinary abnormalities

(Urethral distension)

Question 26

What is uterus masculinus!

Answer 26

Seen in male dogs, may be associated with chronic cystitis. Persistence of mullerian (paramesonephric) ducts.

Tubular / cylindrical hypoechoic extensions typically at craniodorsal aspect of prostate gland and adjacent to the urinary bladder

RARE!! Think Ive seen one…

Question 27

Name three US features of TCC that have been associated with poorer px

Answer 27

Involvement of wall

Trigonal location

Heterogeneous echotexture

Question 28

Name 6 urinary bladder tumours

Answer 28

TCC,

Leiomyoma / Leiomyosarcoma,

Fibrosarcoma,

Rhabdomyosarcoma (YOUNG large breeds)

Lymphoma

Question 29

How are ureterocoeles subcategorized!

Answer 29

Orthotopic vs ectopic

A cyst within a cyst! Or cobra head if contrast

Question 30

Which 2 features of TCC on MRI and CT are described in thrall!

Answer 30

Increased wall invasion and contrast enhancement.

Question 31

Table: radiographic signs of urinary bladder disease

Answer 31