Findings of MRI, CT scan and ultrasound in Marion's disease in a young woman: a case report

Abstract

BackgroundPrimary bladder neck obstruction (PBNO) is a rare condition of the lower urinary tract in young and middle-aged patients. PBNO is a urological condition affecting both sexes in which the bladder neck fails to open adequately during voiding, resulting in obstruction of urinary flow in the absence of anatomic obstruction, such as benign prostatic hypertrophy in men or genitourinary prolapse in women. PBNO may present voiding symptoms (decreased force of stream, hesitancy, intermittent stream, incomplete emptying) or irritative symptoms (frequency, urgency, urge incontinence, nocturia) or a combination of both.Case presentationA 31-year-old female without medical history presented to our department with a 4–5 months history of a sense of incomplete emptying bladder and suprapubic discomfort. In Abdominal and Pelvic CT images of her CT scan, evidence of homogenous concentric hypertrophy of the urethra with mild enhancement in the post-contrast image was seen. Also, pelvic MRI shows isointense on T1- weighted and isointense to mildly hyperintense on T2-weighted Images (to skeletal muscle signal) of the concentric hypertrophy muscular layer of the urethra. The post-contrast image demonstrates moderate enhancement in the hypertrophied urethra. A month later, while the patient had not received any treatment, a pelvic ultrasound showed concentric hypertrophy hypoechoic muscular layer of the urethra.DiscussionThe true prevalence of PBNO is unknown but Farrar et al. reported a 2% prevalence of primary bladder neck obstruction.In 1933, Marion described PBNO as caused by fibrous narrowing of the bladder neck and detrusor hyperplasia. Also, Marion described two types of disease (congenital and acquired) and treatment methods. In this study was shown isointense on T1-weighted and isointense to mildly hyperintense on T2-weighted Images of concentric hypertrophy muscular layer of urethra with moderate enhancement on the post-contrast image. A doughnut sign was also seen in our axial slices (particularly in T2-weighted images), so this sign seems to be a diagnostic finding in MRI. In our study, the diffusion sequence and ADC map showed no obvious restriction.ConclusionsAlthough PBNO has been described for decades, there is still a controversy about diagnosis and treatment. In patients suspected of PBNO, imaging methods, especially MRI, can help confirm the diagnosis or rule out other causes of bladder neck obstruction. In future studies, imaging modalities can be one of the diagnostic criteria for PBNO.