Diagnostic ultrasound ( PDFDrive )

374 PART II Abdominal and Pelvic Sonography
diagnosed and treated, rapid deterioration of renal function may
occur.
BLADDER DIVERTICULA
Bladder diverticula may be congenital or acquired. Congenital
diverticula are known as Hutch diverticula and are located near
the ureteral oriice. Most acquired diverticula result from bladder
outlet obstruction. Bladder mucosa herniates through weak areas
in the wall that are typically located posterolaterally near the
ureteral oriices. he diverticular neck may be narrow or wide.
It is the narrow-neck diverticula that lead to urinary stasis and
give rise to complications, including infection, stones, tumors,
and ureteral obstruction. Tumors arising in a diverticulum have
a poorer prognosis than tumors arising within the bladder.
Diverticula are composed only of mucosa and submucosa, without
the muscularis layer present. Tumors therefore grow and invade
much more quickly into the surrounding perivesical fat.
At sonography, diverticula appear as an outpouching sac from
the bladder. he internal echogenicity of the diverticulum varies
depending on its contents. he neck is oten easily appreciated
(Fig. 9.92, Video 9.4). Urine may be seen lowing into and out
of the diverticulum.
POSTSURGICAL EVALUATION
Nephrectomy
Vascularized retroperitoneal fat is oten placed with partial
nephrectomy defects. he fat may simulate a renal mass at both
CT and ultrasound. At sonography, the mass may be hyperechoic
or isoechoic. 296,297 Surgical history correlation and an awareness
A B C
D
E
F
G H I
FIG. 9.92 Bladder Diverticula: Imaging Spectrum. (A) Large bladder diverticulum containing multiple calculi (arrows). (B) Posterolateral Hutch
diverticulum. (C) Multiple wide-neck diverticula. (D) Multiple diverticula of varying size. (E) Transvaginal sonogram shows an unusual diverticulum
in a woman, with debris in the bladder lumen. (F) Large transitional cell carcinoma with extensive calciication ills the diverticulum. (G)-(I) Patient
with a narrow-neck diverticulum. (H) and (I) Urine low into and out of the diverticulum. See also Video 9.4.