CASE 82

Clinical Presentation

A 7-year-old boy presents who had had previous bladder surgery. An intravenous urogram is performed.

Figure 82A

Radiologic Findings

The kidneys are normal. The bladder appears wider than is usual with a midline septum seen superiorly from previous bladder reconstructive surgery (Fig. 82A). The pubic symphysis shows wide diastasis. (Note gaseous distension of the stomach, produced by a prior carbonated drink, in an attempt to improve visualization of the kidneys.)

• Augmented bladder (But note also pubic symphysis diastasis.)
  
• Neuropathic bladder (classically leads to a cone-shaped bladder, is frequently associated with spinal dysraphism but not diastasis of the symphysis)
  
• Vesicoureteric reflux (Fig. 82A is an intravenous urogram with the renal parenchyma opacified by contrast, and note the urethra is not visible as the patient is not voiding.)
  
• Bladder duplication (extremely rare, is associated with urethral duplication but not pubic symphysis diastasis)

Discussion

Background

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