'Adder head' appearance on voiding cystourethrogram in bladder is feature of
Ans. c (Ureterocele) (Ref: Diagnostic Radiology by Grainger, 4th/pg. 1620, 1739)URETEROCELE# Ureterocele is cystic dilatation of intramural (subepithelial) segment of intravesical part of ureter.# IVU shows early filling of bulbous terminal ureter ("cobra head" appearance) and a radiolucent halo (ureteral wall + adjacent bladder urothelium) giving "spring onion" appearance. Thus, ureterocele leads to repeated infection of renal system and has above explained radiological features.Types# Simple Ureterocele - congenital prolapse of dilated ureter and orifice into the bladder lumen at usual location of trigone and typically is seen with single ureter (orthotopic Ureterocele). 30% cases are bilateral.M:F = 2:3.# Ectopic Ureterocele -usually seen in upper moiety ureter of duplex PC system with 80% incidence.# Pseudoureterocele - no protrusion of ureter into bladder lumen; however, thick irregular halo seen in urinary bladder as e.g., in impacted ureteral calculus (edema in the ureteric wall at the UV junction due to impacted ureteral calculus shows EDLING SIGN, i.e., filling defect surrounded by radiolucent halo of edema).# Caecoureterocele - Ureterocele going into bladder outlet and causing outlet obstruction.# Imaging:# Rx: SurgeryEducational points:X-ray AppearanceDiagnosis"Egg-in-cup" appearance, Ring shadows & HornsPapillary necrosis'Cobra head or adder head' appearanceUreterocele'Flower-vase' ureterHorse-shoe kidney'Cork-screw' ureterTubercular ureteritisFish-hooked/Reverse 'J' ureterBPHNotching of ureterRAS with collaterals'Cow-horn' deformity of ureterSchistosomiasis'Drooping-Lilly' signDuplication of ureter with ectopic ureterFetal head calcification of bladderSchistosomiasis
Horse shoe kidney
VUR
Ureterocele
Carcinoma of urinary bladder
Urogenital System