Urinary bladder diverticula: sonographic diagnosis and interpretive pitfalls.

Abstract

Diverticula of the urinary bladder can occasionally appear as complex pelvic masses not obviously connected to the bladder. Such presentations can lead to diagnostic confusion and interpretative error. Sonographic findings and clinical histories were reviewed in 11 patients in whom bladder diverticula were initially mistaken for other types of pathologic pelvic processes. Sonographic techniques that were helpful in elucidating the true nature of the lesions included scanning from different perspectives with increasing increments of bladder distention, postvoid images, endovaginal views, and color Doppler interrogation. The diagnosis of bladder diverticula should be considered and actively pursued when sonologists are confronted with pelvic masses of ambiguous origin.

Prenatal Diagnosis of a Congenital Bladder Diverticulum

“…They result from a protrusion of the bladder mucus, herniating across the muscle fibers of the detrusor and forming a pseudocystic perivesical mass [5,6]. Approximately 40% of these hernias are congenital and correspond to idiopathic congenital bladder diverticula [1].…”

“…Several presentations can confuse diagnosis and lead to erroneous interpretations [6]. The discovery of a pelvic mass of undetermined origin should suggest a systematic search for a bladder diverticulum [6]. The diagnosis of this anomaly is facilitated when the connection between the bladder and the mass is established, either by visualization of a fluid-filled cavity which is posterolateral to the bladder and which fills up when the bladder empties, or by color Doppler identification of a stream of urine between the two structures [6,[10][11][12][13].…”

“…Postnatal diagnosis of bladder diverticula is often difficult. Several presentations can confuse diagnosis and lead to erroneous interpretations [6]. The discovery of a pelvic mass of undetermined origin should suggest a systematic search for a bladder diverticulum [6].…”

“…The diagnosis of this anomaly is facilitated when the connection between the bladder and the mass is established, either by visualization of a fluid-filled cavity which is posterolateral to the bladder and which fills up when the bladder empties, or by color Doppler identification of a stream of urine between the two structures [6,[10][11][12][13]. Ultrasound (optimal with 5 MHz probes) will of course take long and requires patience, with modifications of the angles of view as well as of the image resolution needed [6,[10][11][12][13]. Several factors can affect these parameters [6,12,14]: narrowed communication between the bladder and the diverticulum can either lead to an uninformative Doppler or prevent complete draining of the diverticulum; an excessively large bladder diverticulum can be mistaken for the bladder, or poor filling of the diverticulum gives it a heterogeneous appearance, simultaneously solid and liquid, and this suggests an abdominal or pelvic cyst.…”

“…The discovery of a pelvic mass of undetermined origin should suggest a systematic search for a bladder diverticulum [6]. The diagnosis of this anomaly is facilitated when the connection between the bladder and the mass is established, either by visualization of a fluid-filled cavity which is posterolateral to the bladder and which fills up when the bladder empties, or by color Doppler identification of a stream of urine between the two structures [6,[10][11][12][13]. Ultrasound (optimal with 5 MHz probes) will of course take long and requires patience, with modifications of the angles of view as well as of the image resolution needed [6,[10][11][12][13].…”