Diagnostic Ultrasound - Abdomen and Pelvis

Ureterocele
Diagnoses: Urinary Tract
TERMINOLOGY
• Cystic balloon-like dilatation of intramural portion of distal
ureter bulging into bladder
• Orthotopic ureterocele (less common): Normal insertion
at trigone and otherwise normal ureter
• Ectopic ureterocele (more common): Inserts below
trigone
• Duplicated collecting system in 80%
IMAGING
• Ectopic: 50% in bladder and 50% in posterior urethra; 10%
bilateral
• US/CT: Thin-walled, cystic intravesical mass continuous with
distal ureter
• Changes in size with degree of ureteral dilation
• Dilated ureter in ectopic lower moiety, changes in size with
degree of ureteral dilation
• IVP/cystogram: Orthotopic ureterocele: Cobra-head
deformity
KEY FACTS
○ Drooping lily sign: Displacement of reflux opacified
lower pole moiety by dilated upper pole moiety
• T2W MR: Superior to demonstrate ectopic ureter
extending from poorly functioning moiety invisible on
other imaging
• US: Obtain images when bladder is reasonably full
• Cystogram: Images during early bladder filling; overfilling
may collapse, obscure, or invert low-pressure ureterocele
PATHOLOGY
• Single system ectopic ureteroceles: Associated with cardiac
and genital anomalies
• Complete duplicated system: Commonly upper moiety
ureter associated with ureterocele
DIAGNOSTIC CHECKLIST
• Look for ureterocele in reasonably full bladder if duplex
renal system detected
(Left) Upper graphic shows
orthotopic ureterocele at
trigone in single system. Lower
graphic shows ectopic
ureterocele with
hydroureter st of the upper
moiety, inserting inferior and
medial to the lower moiety
ureter ſt in duplex system.
(Right) Transabdominal
transverse ultrasound of the
pelvis shows typical
ureterocele as a balloonlike
cyst within the urinary
bladder.
(Left) Transabdominal
longitudinal oblique
ultrasound shows a typical
ureteric duplex system
associated with a ureterocele
within the bladder at
the distal end of the upper
pole moiety ureter. The ureter
is dilated . (Right)
Transabdominal longitudinal
ultrasound through the right
kidney in the same patient
shows duplex collecting
system with dilated upper
moiety and nondilated
lower moiety .
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