Christmas tree neurogenic bladder

Case contributed by Dr Matt Skalski

Presentation

Chronic difficulty emptying bladder. Recurrent urinary tract infections. Otherwise healthy.

Patient Data

Age: 20
Gender: Female
X-ray

Retrograde cystogram showing a bladder that is markedly trebecualted and reduced in capacity. The bladder demonstrates a relative increase in vertical dimension and tapers superiorly, giving the characteristic Christmas tree bladder appearance.

The metallic vascular clips in the right lower quadrant are most likely associated with the reported history of appendectomy. 

A lipomatous lesion extends along the posterior central canal from L1/2 to L3/4. Small central areas of decreased signal are noted. The lesion is effaces and indents the cauda equina. The conus is slightly low, terminating at L2.

Small central disc protrusions are present at L3-L4 and L4-L5.

There is spina bifida occulta at L5 and S1-S3.

Diagram

Diagram of a trabeculated bladder giving the appearance of a Christmas tree. Notice the similarity to the first image in this case. 

Case Discussion

This case represents a neurogenic bladder caused by a tethered cord and related sacral spina bifida occulta.

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Case information

rID: 41884
Case created: 24th Dec 2015
Last edited: 11th Sep 2017
Systems: Urogenital, Spine
Inclusion in quiz mode: Included

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