Revision 4 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 lymphoceles: May develop following radical pelvic lymph node dissection.
    • Extravasated urine/bilateral uromas
    • 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 (Amendola, 1997).
  • 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 (Chang, 1978; Wechsler and Brennan, 1982; Amendola 1997).

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