Presentation
Chronic difficulty emptying bladder. Recurrent urinary tract infections. Otherwise healthy.
Patient Data
Retrograde cystogram showing a bladder that is markedly trabeculated 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.
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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 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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