Pear-shaped bladder

Last revised by Mostafa El-Feky on 23 Mar 2022

Pear-shaped (or teardrop-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 urinomas
    • abscess
  • pelvic lipomatosis: non-malignant overgrowth of fat around the bladder that causes an inverted pear-shaped bladder
  • 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 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, e.g. lymphoma, leukemia
  • 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 predisposes to bladder compression 2,3,6

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Cases and figures

  • Figure 1: pear
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  • Case 1: from hematoma
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  • Figure 2: inverted pear
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  • Case 2: from hematoma (cystogram)
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  • Case 3: from CLL
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  • Case 4: from hematoma (CT)
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