Name the finding on bladder ultrasound and related complication • Xray of the Week
Figure 1. Bladder ultrasound.
Figure 2. Bladder ultrasound- sagittal image. Note the intra-vesicular ureterocele seen as a cystic dilation of the distal ureter bulging into the bladder. There is also a dilated distal ureter due to obstruction.
Ureteroceles form due to the cystic dilation and out-pouching of the distal ureter and may result in ureteral obstruction and impaired renal function. Patients may present asymptomatically or with signs related to obstructed urine outflow such as recurrent urinary tract infections, and renal failure. Classification of ureteroceles is based on location as either intra or extra vesicular. Any child with a urinary tract infection should undergo screening with bladder ultrasound (US) which will typically help identify this congenital anomaly. If US fails to show any deformities, voiding cystourethrogram (VCUG) should be considered and especially in cases of colonization by organisms other than E.coli and in cases of recurrent UTI (1,2).
Ultrasound characteristics of ureteroceles include identification of an ectopic cystic mass, typically near the vesicoureteral junction (VUJ). Radiologic characteristics of ureteroceles consist of a round filling defect near the VUJ and the classical ‘cobra head sign’ that resembles a snake’s head bulging into the bladder. The ‘cobra head sign’ is typically seen with intravesical ureteroceles and is characterized by dilation of the distal ureter (cobra head) with a surrounding radiolucent halo that is seen within contrast-filled bladders on intravenous urograms (1,3).
Symptomatic ureteroceles are typically managed via cystoscopic transurethral incision (4).
1. Adesiyun. Bilateral giant orthotopic ureterocele appearing as kissing cobra in a Nigerian child. Accessed May 8, 2020. http://www.wajradiology.org/article.asp?issn=1115-3474;year=2015;volume=22;issue=1;spage=42;epage=44;aulast=Adesiyun
2. Schultza K, Todab LY. Genetic Basis of Ureterocele. Curr Genomics. 2016;17(1):62-69. doi:10.2174/1389202916666151014222815
3. Genitourinary Radiology. Accessed May 8, 2020. https://www.med-ed.virginia.edu/courses/rad/gu/embryology/ureterocele.html
4. Gottlieb C, Beranbaum SL, Hamilton RH. Radiographic Features of Ureterocele. Radiology. 1953;60(1):64-67. doi:10.1148/60.1.64
Neal Shah is a medical student at The Edward Via College of Osteopathic Medicine (VCOM)–Carolinas and intends on completing his residency within the field of radiology. Prior to medical school, he completed his undergraduate studies at the University of North Carolina at Chapel Hill where he majored in economics and chemistry. During his 4 years there he worked in UNC’s Biomedical Research Imaging Center where he helped develop formulations for iron-oxide nanoparticles used for MRI; it was here that his love for the field of radiology developed. He eventually wishes to also pursue his MBA and hopes to use it to help advance the field of medicine in terms of medical innovation.
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Kevin M. Rice, MD is the president of Global Radiology CME
Dr. Rice is a radiologist with Renaissance Imaging Medical Associates. and is currently the Vice Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator.
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