This 46 year old patient has a long history of paraplegia from a spinal cord injury at T1 level. This image taken from an IVP series shows contrast filling the bladder which has indwelling catheter in it. The elongated and pointed configuration of the bladder is the classic “pine-cone” or “Christmas tree” appearance of a severe neurogenic bladder. This appearance is seen with suprasacral lesions (above S2-S4) which leads to detrusor hyperreflexia and detrusor sphincter dyssynergia, and also epiconal lesions (in and around S2-S4) which also leads to detrusor sphincter dyssynergia.
In contrast suprapontine lesions classically cause rounding of the bladder shape and serration of the mucosa above the trigone. Peripheral lesions (below S2-S4) cause detrusor areflexia and a large atonic bladder. Chronic sensory lesions result in a failure to sense bladder fullness and a large atonic and smooth bladder.
Federle et al. Diagnostic Imaging Abdomen. Amirsys 2004