MedPix Medical Image Database COW - Case of the Week Case Contributor: Eva M. Smietana Affiliation: National Capital Consortium

MedPix No: History Pt Demographics: Age = 73 y.o. Gender = man 73-year old male with chronic renal insufficiency, hypertension and severe coronary artery disease presented for a kidney and bladder ultrasound to assess for hydronephrosis or other renal pathology. Downloaded by (-1)

MedPix No: EXAM & LABS BUN: 26Creatinine: 1.4These were baseline for the patient.

ureteral diverticulum Sagittal ultrasound image of the bladder demonstrates rounded predominently anechoic structure in close proximity to the bladder. The bladder itself is moderatley distended without abnormalities. Downloaded by (-1)

ureteral diverticulum Transverse ultrasound image of the bladder shows the rounded anechoic structure to be contiguous with the bladder. Downloaded by (-1)

ureteral diverticulum Transverse ultrasound image of the bladder shows the rounded anechoic structure to be contiguous with the bladder. The structure appears to be connected to the bladder wall via an anechoic stalk. Downloaded by (-1)

ureteral diverticulum Color Dppler flow image of the bladder shows the right ureteral jet to emerge from the rounded anechoic structure. This would suggest that this is originating from the ureter. Downloaded by (-1)

FINDINGS The urinary bladder demonstrates moderate distention at the time of imaging. At the right ureterovesicular orifice, there is a rounded, predominately anechoic structure which is continuous with the bladder. Color Doppler flow images demonstrate that the right ureteral jet emerges from this structure.

DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? ureterocele - bladder diverticulum - ureteral diverticulum

Diagnosis: ureteral diverticulum Dx Confirmed by: ultrasound imaging

DISCUSSION