Bladder rupture in the setting of bladder outlet obstrcution | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Bladder rupture in the setting of bladder outlet obstruction

Coronal (image 1) and axial (image 2) images from fetal MRI show an abnormal appearance of the kidneys (arrows) with multiple cortical cysts and massive enlargement of the ureters (arrowheads). On postnatal voiding cystourethrogram (image 3) bladder rupture is visible. Contrast fills the urinary bladder (arrowhead). There is leakage of contrast (arrow) from the right lateral aspect of the bladder and pooling (dashed arrow) within the right lower quadrant. Posterior urethral valves is the most common cause of fetal bladder outlet obstruction. Bladder rupture is an uncommon manifestation of this obstruction. High-grade vesicoureteral reflux is more common and leads to kidney damage. Posterior urethral valves as the most common cause of chronic kidney injury in children.

Similar cases

Oblique (image 1) and AP (image 2) voiding cystourethrogram images show a small, trabeculated bladder (arrowhead) with multiple diverticula. The posterior urethra is dilated with a curvilinear filling defect (arrow). There is unilateral grade 5 vesicoureteral reflux (dashed arrow).
Teaching point: Posterior urethral valves cause chronic bladder outlet obstruction, leading to elevated intravesical pressures and progressive renal parenchymal injury. Posterior urethral dilation with a curvilinear intraluminal filling defect is diagnostic. Bladder trabeculation and diverticula reflect long-standing obstruction. Unilateral high-grade vesicoureteral reflux may function as a pressure pop-off mechanism, potentially protecting the contralateral kidney from ongoing damage.

Axial (Image 1) and coronal (Images 2 and 3) T2-weighted MRI show a large pelvic soft tissue mass (arrow), which displaces the bladder and causes obstruction leading to hydronephrosis and hydroureter (dashed arrow). Rhabdomyosarcoma is the most common soft tissue malignancy in the pediatric pelvis. The tumor most commonly originates from the bladder, uterus, vagina, or prostate.

Sagittal CT cystogram shows an extraperitoneal bladder rupture (arrow). Contrast/urine also extends through a defect (dashed arrow) in the anterior abdominal wall. Teaching point: Extraperitoneal rupture is the most common type of bladder rupture and is usually associated with pelvic fractures or penetrating trauma. Intraperitoneal bladder rupture is usually caused by direct blunt trauma to a full bladder.

Lateral image from a voiding cystourethrogram shows a dilated posterior urethra. There is a curvilinear lucency (arrow) in the distal posterior urethra representing a posterior urethral valve. Teaching point: Posterior urethral valves are the most common cause of bladder outlet obstruction in neonates.