Bladder differential diagnosis

CT This technique is useful for assessing intrahepatic carcinoma and detecting peripheral CCC. Occasionally, proximally dilated bile ducts can also be visualized. The gall bladder and the common bile duct are inconspicuous. Differential diagnosis of metastases or HCC can be extremely difficult. (214, 215) MR cholangiography has become an important procedure due to more sophisticated technology, (s. fig. 37.13)... 

This mitochondrial peroxisome enzyme, alpha-meth-ylacyl-CoA racemase (AMACR) (encoded by the gene P504S) catalyzes the racemization of alpha-methyl branched carboxylic coenzyme A thioesters and is present in prostate tissue and a wide variety of carcinomas (colorectal, ovarian, breast, bladder, lung, renal cell), melanoma, and lymphoma.AMACR is useful in prostate needle biopsies when the differential diagnosis... 

Raspollini MR, Nesi G, Baroni G, et al. Immunohistochemistry in the differential diagnosis between primary and secondary intestinal adenocarcinoma of the urinary bladder. Appl Immuno-histochem Mol Morphol. 2005 13 358. 

The clinical presentation is completely different in older children. The main complaint is usually dys-uria or infection (Fig. 6.6). Megacystis and thickening of the bladder wall are less frequent. Kidneys are usually normal, as is renal function. The differential diagnosis should include the other causes of bladder outlet obstruction (see below) and functional disorders such as dysfunctional voiding with severe bladder-sphincter dyscoordination. Both VCU and urodynamic studies can be diagnostic (Fig. 6.7). In case of valves, there is reduced urinary flow with no reinforcement of the perineal electric activity. 

Extremely rare in childhood, the urethral polyp is usually solitary and consists of a pedunculated structure, originating from the posterior urethra, developing in the bladder neck, which can prolapse in the urethra during micturition (Foster and Garrett 1986). Hematuria, nonneurogenic bladder-sphincter dysfunction and infection may reveal the abnormality. On ultrasound, it appears echo-genic. The main differential diagnosis of urethral polyp is an ectopic ureterocele that has ruptured either spontaneously (Fig. 6.8) or after endoscopic... 

Fig. 6.8. Sagittal US view of the bladder neck in a male neonate with left duplicated ureter. The echogenic mass visible in the bladder neck is a spontaneously ruptured ectopic ureterocele, draining the dysplastic upper pole of the duplicated left kidney. Urethral polyp is the main differential diagnosis...

The association of ultrasound, VCU and cystoscopy helps establish a proper differential diagnosis among the causes of congenital or acquired bladder outlet obstruction. 

In children living in Africa, parasitic infection should be included in the differential diagnosis of cystitis. In schistosomiasis, nodular infiltrates of the bladder wall are commonly shown with ultrasound (Fig. 6.14). 

The key questions to address by imaging are as follows is there any urethral leak (the absence of a leak cannot exclude hematoma or contusion) and is there any retrograde opadfication of the bladder (allowing the differential diagnosis between complete and partial disruption of the urethra) The followup of patients is of primary importance. The aim is to detect urethral stenosis or diverticulum. Again, prudent retrograde opacification is the optimal examination. 

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