Diagnostic Ultrasound - Abdomen and Pelvis

Bladder Diverticulum
Diagnoses: Urinary Tract
TERMINOLOGY
• Saccular outpouching from herniation of bladder mucosa
and submucosa through muscular wall of bladder
IMAGING
• Most commonly near ureterovesical junction (UVJ)
• US: Anechoic outpouching from bladder with narrow or
wide neck, may empty with micturition
• May contain calculi, hematoma, or tumor
• Color Doppler shows ureteral jet to and from diverticulum
to bladder
• CT/MR: Fluid attenuation outpouching from bladder
• Usually fills with contrast on excretory post-contrast phase
TOP DIFFERENTIAL DIAGNOSES
• Urachus
• Everted ureterocele
• Paraovarian cysts in female
• Pelvic cysts in male
KEY FACTS
PATHOLOGY
• Acquired: Most common secondary to chronic bladder
outlet obstruction (60%)
• Congenital: Hutch diverticulum (40%)
• Vesicoureteral reflux (VUR)
CLINICAL ISSUES
• Narrow-neck diverticula: Urinary stasis → complications
such as infection, stone, and ureteral obstruction
• Secondary inflammation predisposes to development of
carcinoma within diverticulum
• Complications
○ Carcinoma
○ Vesicoureteral reflux
○ Ureteral obstruction
(Left) Graphic shows a
diverticulum arising from
the lateral bladder wall, due
to herniation of the mucosa
and submucosa through the
muscular wall. (Right)
Transabdominal transverse
oblique ultrasound of the
urinary bladder shows 2 left
posterolateral diverticula
with narrow necks . One of
the diverticula shows a urinary
jet as Doppler signal into the
diverticulum .
(Left) Transabdominal
longitudinal oblique
ultrasound of the urinary
bladder shows a posterior wall
diverticulum . Note mild
wall trabeculation of the
bladder in this patient with
prostatomegaly resulting in
chronic bladder outlet
obstruction. (Right)
Transabdominal transverse
oblique ultrasound in a patient
with neurogenic urinary
bladder shows a trabeculated
bladder wall with multiple
small and 1 large
diverticula .
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