Findings
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📄 Report Sample Line- Bladder diverticulum
Multiple thin-walled, anechoic outpouchings arising from the bladder wall with smooth walls and demonstrate dynamic filling and emptying with bladder activity, consistent with bladder diverticula, demonstrating communication with the bladder lumen. No signs of diverticular inflammation, calculi, or mass within.
Conclusion
📋 Bladder diverticulum
Recommendation:
- Present from birth
- Due to focal weakness in the bladder wall musculature
- Usually solitary and located near the ureterovesical junction
- May be associated with other urogenital anomalies (e.g., posterior urethral valves in children)
- Bladder outlet obstruction
- Neurogenic bladder
- Chronic catheterization
- Recurrent infections or inflammation
- Lower urinary tract symptoms (LUTS):
- Urinary frequency, urgency
- Hesitancy, weak stream
- Incomplete bladder emptying
- Recurrent urinary tract infections (UTIs)
- Post-void dribbling
- Hematuria (gross or microscopic)
- Pelvic or suprapubic discomfort
- Urinary retention (in complicated cases)
- Initial imaging choice
- Shows an anechoic, thin-walled outpouching from the bladder
- May demonstrate communication with bladder lumen
- Real-time observation during voiding may help
- Excellent for showing diverticulum neck and filling dynamics
- Helps assess for vesicoureteral reflux if near ureter
- Direct visualization of diverticular neck and mucosa
- Useful for evaluating associated lesions or tumors
- For complex or complicated cases (e.g., suspicion of tumor, infection, or large diverticula)
- Provides detailed anatomy and wall characteristics
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2. Voiding Cystourethrogram (VCUG): 3. Cystoscopy: 4. CT or MRI:
Related MCQ
1. What is a bladder diverticulum?
A. A solid mass within the bladder
B. A herniation of bladder mucosa through the muscular wall
C. A congenital renal anomaly
D. A calcification in the bladder 👉 Explanation: A bladder diverticulum is an outpouching of the mucosal layer through a weak area in the detrusor muscle.
2. Which is a common cause of acquired bladder diverticulum?
A. Diabetes mellitus
B. Bladder outlet obstruction
C. Hypertension
D. Gallstones 👉 Explanation: Chronic bladder outlet obstruction, such as from BPH, increases intravesical pressure and can cause diverticula formation.
3. What is the most common location of bladder diverticula?
A. Anterior bladder wall
B. Posterior urethra
C. Posterolateral bladder wall
D. Ureteral orifice 👉 Explanation: Diverticula are most commonly found along the posterolateral wall of the bladder.
4. Which imaging modality is best for initial evaluation of bladder diverticulum?
A. MRI
B. CT scan
C. Voiding cystourethrogram
D. Ultrasound 👉 Explanation: Ultrasound is the preferred initial modality due to accessibility and ability to detect outpouchings dynamically.
5. On ultrasound, a bladder diverticulum typically appears as:
A. Hyperechoic mass
B. Cystic outpouching with internal septations
C. Anechoic, thin-walled outpouching communicating with the bladder
D. Calcified structure 👉 Explanation: Diverticula appear as anechoic, smooth-walled sacs connected to the bladder lumen.
6. Which condition is associated with congenital bladder diverticulum?
A. Posterior urethral valves
B. Renal artery stenosis
C. Nephrotic syndrome
D. Glomerulonephritis 👉 Explanation: Congenital bladder diverticula are often associated with posterior urethral valves in pediatric patients.
7. What complication is commonly associated with bladder diverticulum?
A. Gallbladder polyp
B. Ureteral obstruction
C. Urinary tract infection
D. Renal infarct 👉 Explanation: Urine stasis in the diverticulum can predispose to recurrent UTIs.
8. Which of the following symptoms is most typical in a patient with bladder diverticulum?
A. Diarrhea
B. Post-void dribbling
C. Abdominal bloating
D. Flank pain 👉 Explanation: Post-void dribbling is common due to urine retained in the diverticulum.
9. What can be used to confirm the communication of a diverticulum with the bladder?
A. Ultrasound
B. MRI pelvis
C. Voiding cystourethrogram
D. X-ray KUB 👉 Explanation: A VCUG is excellent for demonstrating the neck and dynamic communication of diverticulum with bladder.
10. Which imaging feature on ultrasound suggests a complicated bladder diverticulum?
A. Thin wall and clear fluid
B. Presence of echogenic debris or internal septations
C. Smooth, anechoic sac
D. Well-circumscribed, non-communicating cyst 👉 Explanation: Complicated diverticula may show debris, septations, wall thickening, or calculi.
11. What is a potential long-term complication of untreated bladder diverticulum?
A. Bladder malignancy
B. Nephrotic syndrome
C. Glomerulonephritis
D. Kidney stone 👉 Explanation: Chronic irritation and stasis can increase the risk of urothelial carcinoma developing in a diverticulum.
12. What is the primary treatment for a large, symptomatic bladder diverticulum?
A. Antibiotics
B. Percutaneous aspiration
C. Diverticulectomy
D. Foley catheter 👉 Explanation: Surgical removal (diverticulectomy) is indicated in symptomatic or complicated diverticula.
13. Which of the following is NOT a typical indication for bladder diverticulectomy?
A. UTI
B. Hematuria
C. Asymptomatic small diverticulum
D. Bladder outlet obstruction 👉 Explanation: Asymptomatic small diverticula without complications usually do not require surgery.
14. Which endoscopic procedure can directly visualize the diverticular neck?
A. Ureteroscopy
B. Cystoscopy
C. Colonoscopy
D. Proctoscopy 👉 Explanation: Cystoscopy allows direct inspection of the bladder and diverticular opening.
15. In which of the following patients is a congenital bladder diverticulum most likely?
A. 60-year-old male with BPH
B. 5-year-old boy with recurrent UTI and posterior urethral valves
C. 45-year-old female with urge incontinence
D. 30-year-old male with nephrolithiasis 👉 Explanation: Congenital bladder diverticula are most often seen in children with posterior urethral valves.
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