Take Your Scanning Skills (Case)

Question

What is this structure?

Can you see any abnormalities?

Answer

This structure is the urinary bladder; the two echogenic structures in the dependent portion of the bladder are uroliths. They are confirmed as uroliths as they cast a distal acoustic shadow, seen as the  dark area deep to the surface of the uroliths, this is caused by the mineral content of the urolith;  the ultrasound beam is not transmitted through mineral structures such as bone and uroliths and are absorbed or reflected, resulting in the bright interface at the surface of the structure and the deep region of shadowing extending into the deeper part of the image.

The wall of this urinary bladder is also irregularly thickened, reflecting cystitis associated with the uroliths.  Uroliths will always be in the dependent portion of the urinary bladder and therefore when scanning the bladder it is important to ensure that the entire bladder is imaged as uroliths can be surprisingly easy to miss if the urinary bladder is distended.

Bladder wall masses, such as neoplasia or granulomatous masses will be composed of soft tissue and therefore will transmit the ultrasound beam, so that the structure of the masses can be seen and there is no distal acoustic shadowing.

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