Diagnostic Ultrasound - Abdomen and Pelvis

Abnormal Bladder Wall
□ Uterine carcinoma
□ Vaginal carcinoma
□ Ovarian carcinoma
○ Loss of fat plane between the bladder wall and the
adjacent pelvic neoplasm
○ May have direct intramural and intralesional extension
– May be associated with fistulous communication
○ Color Doppler
– Vascularity of tumor outside bladder cavity may be
demonstrated
Helpful Clues for Less Common Diagnoses
• Fungal Cystitis
○ Candida albicans is most common organism
○ May be associated with fungal ball within bladder
• Tuberculous Cystitis
○ Hematogenous spread of primary tubercular infection,
usually lungs (caused by Mycobacterium tuberculosis)
○ Secondary to renal ± ureteric involvement
○ Earliest form of bladder tuberculous cystitis starts
around ureteral orifice
○ Typically low-volume bladder with diffuse wall thickening
("thimble bladder") ± wall calcification
○ Fibrotic changes near ureteric orifice result in
vesicoureteric reflux
○ Associated with localized or generalized pyonephrosis
• Bladder Schistosomiasis (Bilharziasis of Bladder)
○ Infection of urinary system by parasite Schistosoma
hematobium
○ Thick-walled fibrotic bladder
○ Echogenic calcification within bladder wall
○ Small capacity bladder with inability to completely empty
○ ± hydronephrosis and hydroureter due to distal ureteric
stricture
○ Late complication
– Squamous cell carcinoma of bladder
○ Often difficult to differentiate from tuberculosis based
on imaging
• Emphysematous Cystitis
○ Infection of the bladder wall by gas-forming bacterial or
fungal organism
– E. coli, Enterobacter aerogenes, Klebsiella pneumonia,
Proteus mirabilis
○ Echogenic foci within area of bladder wall thickening
with ring-down artifact
○ Plain radiograph or CT for confirmation
• Invasion by Pelvic Inflammatory Disease
○ Crohn disease: Inflamed bowel or fistula formation
○ Sigmoid colonic diverticulitis
○ Endometriotic pelvic implants
– Diffuse of focal bladder wall thickening, surrounding
inflammatory changes
– Increased vascularity in the inflammatory tissue
SELECTED REFERENCES
1. Lee G et al: Cystitis: from urothelial cell biology to clinical applications.
Biomed Res Int. 2014:473536, 2014
2. Manack A et al: Epidemiology and healthcare utilization of neurogenic
bladder patients in a US claims database. Neurourol Urodyn. 30(3):395-401,
2011
3. Manikandan R et al: Hemorrhagic cystitis: A challenge to the urologist. Indian
J Urol. 26(2):159-66, 2010
4. Vikram R et al: Imaging and staging of transitional cell carcinoma: part 1,
lower urinary tract. AJR Am J Roentgenol. 192(6):1481-7, 2009
5. Figueiredo AA et al: Urogenital tuberculosis: update and review of 8961
cases from the world literature. Rev Urol. 10(3):207-17, 2008
6. Thomas AA et al: Emphysematous cystitis: a review of 135 cases. BJU Int.
100(1):17-20, 2007
7. Wein AJ et al: Overactive bladder: a better understanding of
pathophysiology, diagnosis and management. J Urol. 175(3 Pt 2):S5-10,
2006
8. Wong-You-Cheong JJ et al: From the archives of the AFIP: Inflammatory and
nonneoplastic bladder masses: radiologic-pathologic correlation.
Radiographics. 26(6):1847-68, 2006
9. Abrams P: Bladder outlet obstruction index, bladder contractility index and
bladder voiding efficiency: three simple indices to define bladder voiding
function. BJU Int. 84(1):14-5, 1999
Differential Diagnoses: Urinary Tract
Underfilled/Underdistended Bladder
Normal Trigone
(Left) Transverse
transabdominal ultrasound
shows an apparent uniformly
thickened wall of an
underdistended bladder ſt.
The bladder wall was normal
after optimal distension.
(Right) Transverse
transabdominal ultrasound
shows a focal thickening st at
the interureteric ridge
(trigone), a normal finding.
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