Revision 19 for 'Pear-shaped bladder'

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Pear-shaped bladder

A pear-shaped (or tear-drop-shaped) bladder is one whose normal round or ovoid shape has been extrinsically compressed to resemble a pear. The pear may be inverted or upright, depending on how the excess pelvic tissue compresses the bladder. Causes of a pear-shaped bladder include:

  • pelvic fluid
    • pelvic hematoma - the original description of the inverted pear-shaped bladder was in patients with pelvic trauma and hematoma; it can also be seen in patients receiving anticoagulation therapy.
    • bilateral lymphocoeles - may develop following radical pelvic lymph node dissection.
    • extravasated urine/bilateral urinomas
    • abscess
  • pelvic lipomatosis - non-malignant overgrowth of fat around the bladder that causes an inverted pear-shaped bladder. Most common in middle-aged black men.
  • vascular dilatation
    • bilateral iliac artery aneurysms; upright pear-shape.
    • inferior vena cava (IVC) occlusion; causes formation of collateral vessels that compress the bladder and form an inverted pear-shaped bladder. In the olden days of intravenous urograms, the combination of a renal mass and a pear-shaped bladder was a red flag for renal cell carcinoma involving the renal vein and IVC 2
  • symmetric lymph node enlargement
  • psoas muscle hypertrophy
    • upright pear-shape - especially in people with narrow pelvises.
    • a ratio of the (sum of the widths of the two psoas muscles):(the pelvic width)>0.98 makes predisposes to bladder compression 2-3,6.

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