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Case of the Week 30 2015

*3 day-old male neonate with leg swelling

What is the most likely diagnosis?

1-Neurogenic bladder
2-Urethral atresia
3-Posterior urethral valve
4-Prune-belly syndrome

Answer

Answer: Posterior urethral valve

Case Discussion:

Ultrasound images demonstrate hyperechoic kidneys, hydronephrosis, hydroureter, and keyhole sign.

Posterior urethral valves are abnormal congenital obstructing membrane that is located in the posterior male urethra and the most common cause of bladder outlet obstruction in infancy.

Ultrasound
• Keyhole sign: thick-walled, trabeculated bladder and elongated, dilated posterior urethra.
• Hydronephrosis and hydroureter can or cannot be present.
• Kidneys can be hyperechoic with loss of the normal corticomedullary differentiation.
• Pararenal urinoma secondary to rupture of a calyceal fornix.
• Intraperitoneal fluid secondary to intraperitoneal bladder rupture.

References:
1. Berrocal T, López-pereira P, Arjonilla A et-al. Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features. Radiographics. 22 (5): 1139-64.
2. Blews DE. Sonography of the neonatal genitourinary tract. Radiol. Clin. North Am.