Ch. 42- Urinary bladder

Question 1

What are the most commonly involved structures in acquired or congenital fistulas?

Answer 1

rectum and vagina

Question 2

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?

Answer 2

Do a compression view

Question 3

Radiographic signs observed with UB disease include:

Answer 3

Irregular mucosal border, intramural thickening, filling defects, and leakage.

Question 4

CT- excretory urography is helpful to dx what congenital condition?

Answer 4

ectopic ureters

Question 5

What are some complications of cystography?

Answer 5

Mucosal ulceration, inflammation, granulomatous reactions (are transient)

Gas embolism (if doing a double contrast cystography)

Question 6

What are the ligaments that hold the urinary bladder in place?

Answer 6

Ventral ligament of the UB (1)

Lateral ligaments of the UB (2)

Question 7

What’s your most important radiographic interpretation?

Answer 7

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 .

Question 8

What is the best procedure (per Thrall) for identifying urinary bladder location, tears, hernias, and abnormal communication with adjacent structures?

Answer 8

Positive contrast cystography

Question 9

What is your radiographic interpretation?

Answer 9

UB wall appears subjectively thickened

Multiple well-defined rounded variable in size filling defects outlined by the contrast medium (consistent with radioluscent uroliths)

Question 10

What is your most likely dx?

Answer 10

TCC

Question 11

What’s your ultrasonographic findings?

Answer 11

Multiple hyperechoic foci within the UB lumen consistent w/ debris (crystalline debris)

Question 12

Attached filling defects may be cause by:

Answer 12

neoplasia, polyps, blood clots, adherent calculi, and ureteroceles

Question 13

The urinary bladder is divided in three parts. What are they?

Answer 13

Apex- cranial

Body- middle

Neck- caudal

Question 14

What is your dx?

Answer 14

a UB diverticulum. In this case it was due to a post traumatic effect

Question 15

What’s your main CT image finding?

Answer 15

ureter inserts at the level of the neck of the UB= ectopic ureter

Question 16

What are some causes for UB wall thickening?

Answer 16

fibrous tissue proliferation or cellular infiltration from inflammation (cystitis)m hemorrhage or neoplasia

Question 17

What’s you dx?

Answer 17

A large hyperechoic structure creating acoustic shadowing consistent w/ calculi

There is also irregular thickening of the craioventral UB wall

Question 18

What is the normal UB wall thickeness ?

Answer 18

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

Question 19

What is the most common site for TCCs to be located?

Answer 19

Neck of UB

Question 20

What is your sonographic finding?

Answer 20

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

Question 21

What is your main CT image finding?

Answer 21

heterogeneous irregularly marginated hyperattenuating material within the UB wall= UB mass

Question 22

What’s your dx? With what endocrine disease is this commonly seen?

Answer 22

Emphysematous cystitis.

This is commonly seen in diabetic patients.

Question 23

Which cystics calculi are radiopaque? What about radioluscent?

Answer 23

radiopaque: calcium oxalate or phosphate, struvite, silica
radioluscent: urate, cystine

Question 24

What is the cobra-head sign?

Answer 24

when ureteroceles communicate partially with the UB and fill with positive-contrast medium or they may not communicate and create a negative filling defect

Question 25

What's your dx?

Answer 25

Polypoid cystitis Often located in the cranioventral and craniodorsal portions of the UB wall

Question 26

What are some common causes of free filling defects?

Answer 26

gas bubbles, calculi, blood clots

Question 27

What's your dx?

Answer 27

There are multiple linear hyperechogenicities. Some have reverberation artifact some don't. This is consistent w/ emphysematous cystitis.

Question 28

What's your radiographic finding of this post double ocntrast cystography?

Answer 28

Mild mucosal irregularity of the wall of the UB at the level of the apex. You can see these changes with chronic cystitis

Question 29

What procedure is best for assesing UB wall lesions and intraluminal filling defects?

Answer 29

A double contrast cystography

Question 30

How do smooth muscle neoplasia appear on ultrasound?

Answer 30

As a single, round, well-defined intraluminal mass

Question 31

What is the best technique to assess leakage of urine from the UB?

Answer 31

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

Question 32

Where are urinary bladder fibrosarcomas and rhabdomyosarcomas are often located?

Answer 32

the neck of the UB and are typically found in young dogs

Question 33

What is your dx? This is a male dog.

Answer 33

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.

Question 34

Both negative- and positive-contrast media can be used for cystography. Negative contrast media include:\_\_\_\_\_\_\_. What about positive contrast media?

Answer 34

negative media: room air, CO2, nitrous oxide positive media: water soluble organic iodines. Never use barium for cystography