Presentation
Patient with known urethral diverticulum. On physical exam, the urologist palpated some firm nodules around the urethra. MRI to confirm stones.
Patient Data
There is an irregular horseshoe/saddle shaped urethral diverticulum, with the larger component on the right. Within this larger component, there are several T1 and T2 hypointense oval and irregular structures, compatible with stones. The stones are highlighted on the T1 weighted sequence due to the relatively homogeneous T1 isointensity of the surrounding structures.
(Of note, an endovaginal coil is being used)
Annotated images pointing out the urethral diverticulum stones. The open gray arrows point toward the stones on the different sequences.
Case Discussion
One of the complications of a urethral diverticulum is stone formation within the diverticulum.
These would appear as filling defects within the diverticulum on a VCUG or a double-balloon retrograde urethrogram, but it may be impossible to detect them if they are not calcified and if the diverticulum does not fill.
MRI is a more reliable way to assess urethral diverticulum stones. The urethral diverticulum is more reliably imaged, regardless of its size, and the stones are hypointense on both T1 and T2 weighted sequences.