Diagnostic Ultrasound - Abdomen and Pelvis

Schistosomiasis, Bladder
Diagnoses: Urinary Tract
TERMINOLOGY
• Bilharziasis, parasitic infection
• Infection of urinary system by parasite Schistosoma
hematobium
IMAGING
• Imaging findings mirror pathologic course
○ Acute phase: Nodular bladder wall thickening
○ Chronic phase: Contracted, fibrotic, thick-walled bladder
with calcifications
• Calcifications of bladder wall (4-56%)
○ ± calcification of ureter (34%), seminal vesicle (late)
○ Calcification best seen on NECT
• Mucosal irregularity, inflammatory pseudopolyps of
bladder
• Ureteritis cystica, distal ureteric stricture
• Noncompliant, small-capacity bladder with significant
postvoid residual
KEY FACTS
TOP DIFFERENTIAL DIAGNOSES
• Bladder calculi
• Bladder carcinoma
• Cystitis
○ Emphysematous cystitis
PATHOLOGY
• Cercariae pass from snail (intermediate host) to water and
penetrate human skin
• Pass into lymphatics, lungs, and liver and migrate to pelvic
venous plexus → bladder wall vessels
CLINICAL ISSUES
• Endemic in Middle East, India, Africa, Central America, and
South America
• Diagnosis is confirmed by identifying ova of parasite in
urine
• Squamous cell carcinoma of bladder is late complication
(Left) Graphic shows a
markedly thickened urinary
bladder wall with
inflammatory polyps ſt and
mural calcifications .
Ureteritis cystica changes
are present in the dilated right
ureter. (Right) Transverse
transabdominal ultrasound of
the bladder shows mild diffuse
wall thickening ſt with linear
echogenicity in the wall st
from subtle wall calcification
in a patient with
schistosomiasis.
(Left) Longitudinal
transabdominal ultrasound of
the bladder shows diffuse wall
thickening ſt with linear
mucosal echogenicity st from
calcification in a patient with
schistosomiasis.(Courtesy E.
Wassal, MD, and A Abdelaziz,
MD.) (Right) Axial CECT shows
diffuse bladder wall
calcification ſt, consistent
with chronic phase of
schistosomiasis infection.
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