MRI
Axial T2 fat sat
Coronal T2 fat sat
Sagittal T2 fat sat
Sagittal T1
Sagittal T1 C+
Axial T1 C+
IDC in situ within the bladder, which contains gas (likely iatrogenic) and is decompressed
- Within the pelvis is a large, well-defined cystic appearing structure measuring 35 x 29 x 60mm (AP x TR x CC) and containing heterogeneous T2 intense fluid, with wall enhancement.
- The lesion appears more serpiginous than loculated, with intrinsic septations, and tapers distally towards the prostate and anterior rectal wall, which is the suspected site of origin.
- The rectum is displaced anteriorly and the sigmoid is displaced to the left and effaced, although there is no overt features of acute obstruction.
- Both the ureters and outflow vessels are splayed laterally by the mass. While the lesion abuts the sacrum from the S3 level to L5/S1, it does not appear to arise from or communicate with any presarcral or cord structures.
- There is no osseous erosions, and no invasion of adjacent tissues or bone. No fistulous connections are appreciated.
The primary lesion causes bilateral hydronephrosis and hydrouterter, which appears similar to recent ultrasound imaging. Renal pelvis dimensions measure 11mm on the left and 10mm on the right, with obvious calyceal dilatation. Distal ureters measure 5mm on the left and 3mm on the right, with abrupt compression at the level of the common iliac arteries as they become compressed by the mass.
Fusiform distal dural sac ectasia extending from the T11 level to S1. There is no scalloping of the vertebrae posteriorly and there is no evidence of cord tethering or external communications. The cauda equina appear displaced anteriorly at this level.
No suspicious lymphadenopathy. No concerning osseous lesion.
IMPRESSION
Serpiginous, fluid-filled cystic pelvic mass which appears to be arising within the region of the recto-vesical space. The appearance and wall topography are reminiscent of bowel wall, however, there is no definite connection to bowel, and it appears to be communicating in close proximity to the prostate.
Bilateral hydroureter and hydronephrosis secondary to extrinsic distal ureteric compression at the level of the CIAs.