Presentation
There is background dysuria, urinary discomfort and a history of urinary retention. Epigastric fullness on clinical examination.
Patient Data
There is age-expected prostatomegaly with approximately 76 cc in volume with an enlarged median lobe projected into the bladder trigone. The bladder is moderately distended with trabeculation and diverticulation suggesting chronic bladder outlet obstruction. There is a large, simple, urinary bladder diverticulum extending superiorly to L2/L3 vertebral body level and measures 11 cm in diameter. There is no bladder wall calcification, and no suspicious intraluminal filling defects or bladder masses. There is no nephroureterolithiasis and no bladder calculi
Additional findings:
uncomplicated calcific cholelithiasis
no occult osseus lesions
Delayed-prone imaging demonstrates the dense contrast-urine level within the bladder and a dilute contrast-urine level within the large urinary bladder diverticulum, confirming bladder communication.
Bladder trabeculation is well delineated by the urinary contrast.
There are no suspicious masses within the bladder and within the large diverticulum.
Case Discussion
Features consistent with a large, acquired or secondary urinary bladder diverticulum. Acquired diverticula at this age are generally secondary to a cause of bladder outlet obstruction and include prostatomegaly, neurogenic bladder, and urethral stricture. In this instance, prostatomegaly and chronic bladder outlet obstruction was the likely cause.
Sonographically, the poor identification of bladder communication, unfortunately, directs to a differential diagnosis for simple intrabdominal cystic masses including mesenteric cysts, pancreatic pseudocysts, and hydatidosis.
Case courtesy: Dr K. Govender.