Of these patients, nine had ureteral wall thickening (33.3%) and two (7.4%) had ureterovesical junction involvement (ie, they had hydronephrosis but no ureteral wall thickening). There is also a small rind of circumferential para-aortic soft tissue, characteristic of the . The bladder wall may be thickened if: > 3 mm when distended > 5 mm when nondistended If the bladder is not distended, then it is difficult to exclude artifactual thickening from a collapsed bladder Post-void increase of dilatation of collecting system and pelvic urothelial thickening (Fig. 10 . A simple ureterocoele refers to a ureterocoele associated with a normally positioned vesico-ureteric junction (VUJ) (at the lateral aspect of the trigone). We are developing a computer-aided detection (CAD) system for automated detection of ureteral wall thickening on multi-detector row CT urography, which potentially can assist radiologists in detecting ureter cancer. Urothelial thickening is an important radiologic sign of tumor, especially in the pelvicalyceal system. Key points • Thickening of the bowel wall may be focal (<5 cm) and segmental or diffuse (6-40 cm or >40 cm) in extension. It accounts for only 1% of all upper urinary tract malignancies 1 . In the first stage of our CAD system, given a starting point, the ureter is tracked based on the CT values of the contrast-filled lumen. Endometrial hyperplasia is an abnormal proliferation of the endometrial glands and stroma, defined as diffuse smooth thickening >10 mm 13. With the widespread implementation of CT urography, it is critical for radiologists to understand normal ureteral anatomy and the varied appearance of pathologic ureteral conditions at CT urography. Imaging helps in both diagnosis and staging of ureteric tumors, as well as in post - treatment follow-up [2]. Dilatation and a ragged irregular appearance of the urothelium are the first signs of ureteral tuberculosis, being that the distal third of the ureter is the most commonly involved. The longer BOO/BPO exists the thicker the bladder wall and heavier the bladder become in both animals and humans. The left kidney showed normal parenchymal enhancement, opacified nondilated collecting systems and ureter. P Jha, M Sakala, LP Chamie, M Feldman et al., Endometriosis MRI lexicon: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. A, B. Complications of urethral diverticulum may also be evident on MRI. 2 consisted of symmetric circumferential ureteral wall thickening without (pattern 1) and with (pat-tern 2) spiculation around the lesion. In any case, the presence of regions that are not well opacified No other renal or ureteral lesions were present. Excretory phase depicted a mild irregular wall thickening with no intraluminal filling defect. Delayed excretory-phase CT revealed infundibular narrowing as well as long-segment mural thickening, luminal narrowing, and irregularity of the right ureter (,,, Fig 3). Materials and methods: 93% (15/16) of the . With an estimated 70,530 new cases and 14,680 deaths in the United States in 2010, bladder cancer is the most common malignancy of the urothelium and kidneys [].Metachronous disease is common, and surveillance for additional tumors is a lifelong challenge in patients with bladder cancer [].. CT urography (CTU) is defined as a CT examination of the urinary tract that is performed . Similar finding was seen in the distal third of both ureters (no image available). Ureteral wall thickening was defined as a thickened ureteral wall of more than 2 mm with noticeable distinction compared with that of the ipsilateral ureteral wall [22]. Pathology: Congenital prolapse of dilated distal ureter and orifice into bladder lumen at the usual location of the trigone, typically seen with single ureter. Corticomedullary phase did not depict an enhancing renal or ureteral mass. Thus, complete ureteral obstruction may be a reliable imaging feature for the periureteral fat invasion in ureteral cancer. Varying dilatation of ureter that may exhibit wall thickening. Iodinated contrast medium was therefore administered during the procedure. These abnormalities are reviewed, along with the indica- The cause of ureteral dilatation was evaluated on CT Urography by two radiologists, VR and Shuchi Bhatt, independently. Fig. D. Voiding cystourethrogram confirms a high-grade reflux into the single urinary system. The narrowed segment of ureter demonstrates circumferential wall thickening and mucosal irregularity. Pattern 5 was a mass with a smooth external . Bladder wall hypertrophy and increased bladder weight are the physiologic responses of the urinary bladder to BOO/BPO. • Regular, symmetric and homogeneous wall . Urothelial thickening is an important radiologic sign of tumor, especially in the pelvicalyceal system. Pathologic findings at CT urography include congenital abnormalities, filling defects, dilatation, narrowing, and deviations in course. Methods and materials: Data from 3000 consecutive patients who underwent diagnostic cystoscopy at a single institution from 2006-2009 were collected retrospectively. Urethral TCC is associated with a hypoechoic and thickened wall with a hyperechoic mucosal lining (Figure 13). 1 63 Furthermore, MRI findings show a hypointensity on T2-weighted images in patients with ureteral amyloidosis, whereas UTUC is usually seen . ureteric stenosis 3; Differential diagnosis. Ureteral cancer happens when cells on the inside lining of the ureter develop changes (mutations) in their DNA. 1). Introduction. wall thickness and any irregularities of the bladder mucosal surface and to rule out the presence of radiolucent cystouroliths (Figure 20, next page). Differential diagnosis for bladder wall thickeningdepends on whether the bladder is adequately distended. Bowel wall thickening was the most common appearance of gastrointestinal involvement in our series, more commonly involving a short segment (< 10 cm) than long segment (> 10 cm), and 2× more likely to involve multiple sites than a single site (Fig. showed thickening of the left ureteral wall. In the CECT axial scans, in the arterial (30 s) and venous (80 s) phases (a, b), we note the presence of a wall thickening (white arrows) of the proximal ureter with poor enhancement in post-contrast phases, determining the upstream dilatation.The lesion (white arrows) is sufficiently detectable in sagittal (c) and coronal (d) scans.Periureteral fat tissue stranding is associated (a) (red arrow). The presence of a ureteral lesion or wall thickening can also cause a narrowing of the ureter lumen, 155 which will result in a region not well opacified with excreted IV contrast material, although the ureteral wall will often be thickened. Introduction: The purpose of this study was to evaluate the yield of cystoscopy in detecting bladder malignancy following incidentally identified bladder wall thickening observed on computed tomography (CT) scans. This thickening extends to the proximal urethra and the lumen of the proximal urethra is mildly dilated. Infections can set in, which may cause further thickening and inflammation in the ureter, bladder, and pelvic walls. The tracking program successfully tracked the 25 ureters (22 abnormal and 3 normal) and detected 90% (20/22) of the ureters having wall thickening with 2.3 (7/3) FPs per ureter. To definitivelydiagnoseIgG4-relateddisease, we initially planned CT-guided biopsy of the ureter. 9 ). The changes tell the cells to multiply rapidly and to continue living beyond their typical life cycle. 6A and 6B ). One patient had a ureteral obstruction because of a ureter stone. Metastases Metastases to the ureter are extremely rare but have been reported in association with melanoma, as well as breast, prostate, and colon cancers [ 7 ]. A cell's DNA contains the instructions that tell a cell what to do. Rupture of the ureter with subsequent extravasation of urine, although uncommon, can result from external trauma, surgical injury, ureteral instrumentation, or ureteral obstruction by a calculus or tumour and rarely, as in this case, due to back pressure from bladder wall thickening and reduced bladder capacity causing urinary tract obstruction. The presence of wall thickening, gallstones, and sonographic Murphy's sign are highly specific in predicting need for OR [8] Biliary POCUS associated with significantly shorter ED length-of-stay compared to that of patients undergoing radiology ultrasonography [8-9] along ureteral wall. • Focal, irregular and asymmetrical thickening of the bowel wall suggests a malignancy. Abdominal Radiology (2019) 10.1007/s00261-019-02291-x. 6.-Transitional cell carcinoma presenting as wall thickening and periureteral in- Fig. Ureteroscopically guided biopsy may be used for additional up - per urinary tract evaluation. - Ureteral tuberculosis. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Axial (A) and coronal (B) contrast-enhanced CT (corticomedullary phase) demonstrates right perinephric stranding with a rounded area of hypodensity in the renal parenchyma (arrows), consistent with focal nephritis. Ureteritis was diagnosed in the presence of diffuse, mild to moderate, circumferential ureteral wall thickening and enhancement associated with periureteric stranding [ 7 ]. Diffuse Bladder Wall Thickening . (2) Prolapse into bladder neck / urethra causing obstruction (rare) (3) Wall thickening secondary to edema from impacted stone / infection. Serum immunoglobulin (Ig)G4 level was high (348 mg/dl). The right ureter was thickened and demonstrated abnormal mural enhancement (,,, Fig 2b). Fig. Pathologically, early stage carcinomas are limited to the ureteral wall and do not invade periureteric fat. 12-14 The bladder wall thickness should not exceed 3 mm for a distended bladder or 5 mm for a nondistended bladder. Post-void increase of dilatation of collecting system and pelvic urothelial thickening (Fig. Bladder Wall Thickening or Tumors. PUWT was defined as a thickened renal pelvic and/or ureteral wall of more than 2 mm with noticeable distinction based on contrast-enhanced CT at any phase as compared to that of the ipsilateral pelvic/ureteral wall. Prenatal sonographic diagnosis of posterior urethral valves: Identification of valves and thickening of the posterior urethral wall October 1998 Journal of Clinical Ultrasound 26(7):366-70 Focal bladder wall thickening urothelial cell carcinoma of the bladder (transitional cell carcinoma) artifact: blood products / clot will not enhance on postcontrast CT or MRI; no vascularity on color Doppler may be adherent to the bladder wall, like tumor, but clot is more likely to have a concave margin, unlike tumor other bladder neoplasm 3). If the diverticulum demonstrates irregular margins, wall thickening, or other features suspicious for malignancy, the clinician should obtain pre- and postcontrast, fat-saturated T1- sequences. An axial portal venous phase contrast-enhanced CT through the abdomen in a patient with bilateral ureteral stents shows marked proximal left ureteral wall thickening (arrow). diffuse, circumferential urothelial wall thickening and contrast-enhancement; periureteric or perinephric fat stranding 1; Treatment and prognosis Complications. The ureterocoele wall is composed of bladder and ureteral epithelium and the ureteric orifice may be stenosed or obstructed. parenchymal thickness less than 12 mm [21]. had ureteral wall thickening (33.3%) and two (7.4%) had ureterovesical junction involvement (ie, they had hydronephrosis but no ureteral wall thickening). Introduction . On CT urography or MRU, it is seen as focal or diffuse ureteric wall thickening with or without periureteric stranding, ureteral filling defects, or focal masses (Figs. Diffuse bladder wall thickening is probably most commonly seen when the bladder is incompletely filled with urine. 10.18). The most common primary cancer is stomach cancer. Initial investigations focused on the ultrasound appearance of the bladder wall and demonstrated that the detrusor appears as a hypoechogenic (black) area . This study was performed to characterize renal pelvic and ureteral wall thickening (PUWT) in renal cell carcinoma (RCC) patients, including prevalence, cause, and detailed radiological findings based on contrast-enhanced CT, and to correlate these features with corresponding pathological findings. VCUG demonstrates the stenotic segment and the associated alterations (, Fig 27) (, 94). 42 Hydronephrosis tends not to be severe, despite the presence of lesions over long segments, and low signal wall thickening in T2WI suggests amyloidosis. Bladder changes comprise of wall thickening, haziness initially followed by calcification, fibrosis and contraction with reduced capacity. Indirect signs in bladder: bladder wall thickening, trabeculation, lateralisation of ostium and gaping ostium. Contrast-enhanced CT of the abdomen in venous phase shows a hypodense, homogeneous, circumferential and diffuse wall thickening of the infra-renal aorta (Figure 1), extending to the iliac arteries (Figure 2) and involving the lumbar segment of the left ureter, causing a significant left ureterohydronephrosis. The presence of a ureteral lesion or wall thickening can also cause a narrowing of the ureter lumen, 155 which will result in a region not well opacified with excreted IV contrast material, although the ureteral wall will often be thickened. Findings Specifically Related to the Ureteral Orifice • Ureterocele • Ureteral reimplantation site • Infiltrating tumors are characterized by thickening and induration of the ureteral or renal pelvic wall. Ureteral amyloidosis also shows a thickened ureteral wall with slight enhancement, often accompanied by intratumoral calcification. Keywords: CT urography, upper tract, urothelial tumors Introduction Urothelial carcinoma affects more than 70,000 Americans annually [ 1 ]. Publication types Research Support, Non-U.S. Gov't MeSH terms Aged, 80 and over Carcinoma, Transitional Cell / diagnostic imaging* Female Abnormalities of the bladder wall include focal or generalized thickening, loss of integrity, and abnormal vascularity. Echogenic clots may . Circumferential wall thickening of the urinary bladder was detected, more pronounced on its right side, with perceptible contrast enhancement during the venous phase. 1). 15 SCC is most commonly associated with the distal urethra. There are 2 mildly hypoechoic nodules with Doppler flow situated over the ureteral papillae. Advanced ureteral fibrosis owing to multiple strictures and mural calcification may be seen. The ureter is the least common location for transitional cell carcinoma (TCC) of the urinary tract, 2-3 times less common than TCC of the renal pelvis, and 100 times less common than transitional cell carcinoma of the bladder. Epidemiology. The bladder walls become stretched, and the walls of the bladder, ureters, and renal pelvis may thicken. They may involve one side or both, the trigone or bladder base, and can be fine, granular, or thick and irregular. 1 While appendicitis is the most common cause of the surgical abdomen, a wide variety of acute gastrointestinal, genitourinary, and gynecological pathologic processes can present in . It shows irregular wall thickening of the ureter, periureteral fat infiltration, and hydroureteronephrosis in computed tomography. Renal cell carcinoma (RCC) is the most frequent renal malignancy and is commonly detected by ultrasonography or CT. Contrast-enhanced CT is an essential imaging modality to determine tumor characteristics, differentiate RCCs from benign renal … Also both urinalysis and cystoscopy were negative. 10.18). Pearls and Pitfalls in the Diagnosis of Ureterolithiasis with Unenhanced Helical CT. 1 From the Department of Diagnostic Radiology, Wilford Hall Medical Center (59 MDW/MTRD), 2200 Bergquist Dr, Suite 1, Lackland Air Force Base, TX 78236-5302. The bladder has to be fully distended with urine to say that the bladder wall thickening represents an abnormality. Pattern 4 was asymmetric circumferential ureteral wall thickening with spiculation. No renal or ureteral stone or peri-ureteral stranding was present excluding therefore an inflammatory cause for the mural thickening. Acute abdominal pain is the most common reason for an emergency department visit among patients age 15 and older, a large portion of them will complain of pain localizing to the right lower quadrant. 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