Diagnostic ultrasound ( PDFDrive )

1910 PART V Pediatric Sonography
B
A
FIG. 54.63 Seminal Vesicle Cyst in 17-Year-Old Male With Right Renal Agenesis. (A) Transverse sonogram shows tubular structure (arrow)
with a rounded portion projected over bladder (B). (B) Intraoperative cystoscopic retrograde injection of contrast material conirms the presence
of a seminal vesicle cyst.
B
Bladder
Utricle
FIG. 54.64 Prostatic Utricle in 4-Year-Old True Hermaphrodite. This
child was reared as a boy after external genitalia reconstruction. Sagittal
view of the bladder reveals a luid-illed, tubular utricle posterior to the
bladder base.
muscle. Anechoic spaces caused by necrosis and hemorrhage
are occasionally seen (Fig. 54.68). Calciication is uncommon.
Bladder lesions originate in the submucosa, iniltrate the bladder
wall, and produce polypoid projections into the lumen (sarcoma
botryoides). Tumors arising in the prostate cause concentric or
asymmetrical enlargement of the prostate and oten iniltrate
the bladder neck, posterior urethra, and perirectal tissues (Fig.
54.69). Regional and retroperitoneal lymph node metastases are
common. Rarely, leiomyosarcoma may arise from the bladder
wall and is more likely to have calciications.
Benign tumors of the lower urinary tract are extremely rare
and include transitional cell papilloma (neuroibroma, ibroma,
hemangioma, and leiomyoma). 219,220 Neuroibromatosis can be
invasive, with difuse involvement of the pelvic organs. 221 Pheochromocytoma
of the bladder is a rare tumor that probably
arises in the paraganglia of the visceral (autonomic) nervous
FIG. 54.65 Viral Cystitis in 11-Year-Old Boy With Frequency,
Hematuria, and Dysuria. Transverse sonogram shows lobulated
thickening (cursors) of the bladder wall.
system and is located submucosally either in the dome or in the
posterior wall close to the trigone. In children, 2% of bladder
pheochromocytomas are malignant. Pheochromocytomas can
be seen in the context of familial syndromes or diseases, which
include neuroibromatosis, von Hippel–Lindau disease, Sturge-
Weber syndrome, tuberous sclerosis, multiple endocrine
neoplasia type A (medullary thyroid carcinoma and hyperparathyroidism),
and multiple endocrine neoplasia type IIB
(medullary thyroid carcinoma, mucosal neuromas, and pheochromocytoma).
Pheochromocytomas of the bladder may cause
headache, blurred vision, diaphoresis, palpitations, intermittent
hypertension (70%), and hematuria (6%). Any of these symptoms