Presentation
Long standing urinary bladder outlet obstruction and poor urinary stream.
Patient Data
A vertical urinary bladder with wall thickening causes an irregular outline resembling a Pine cone bladder or Christmas tree appearance.
Moderate dilatation of the urinary drainage system is seen at both sides, accompanied by decreased renal function bilaterally. Several renal cortical cysts are also evident.
The urinary bladder shows severe uneven wall thickening with a few varying sized fluid density outpouchings, suggesting diverticula. A Foley catheter is seen in the bladder.
Despite more than 30 minutes delay, the urinary bladder didn’t fill by contrast media.
The prostate gland is enlarged.
Case Discussion
Pine cone or Christmas tree bladder is usually seen in severe neurogenic bladder with increased sphincter tone. Still, it's not pathognomonic and may also be seen in bladder outlet obstruction due to non-neurogenic causes.