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Discussion
Despite the fact that hemorrhagic cystitis is not a specific
term of diagnosis, it is frequently applied to cystitis with prominent
hematuria. It is usually associated with acute infectious cystitis
caused by adenovirus (1). It is common in young children and immuno-compromised
patients with a history of organ transplantation (1). In addition,
hemorrhagic cystitis may develop as a drug-induced cystitis in
patients undergoing, for example, cyclophosphamide therapy (2).
Normal or diffuse bladder wall thickening is the usual manifestation
of hemorrhagic cystitis. However, in its localized form, it appears
as a focal mass-like lesion and may be misinterpreted as a bladder
tumor.
The differential diagnosis requires one to distinguish hemorrhagic
cystitis from bladder tumors. Plain radiograph (Fig
1) with contrast illustrates a mass-like filling defect (arrows)
in the right wall of the bladder mimicking bladder carcinoma.
Contrast-enhanced CT scan (Fig
2) shows a localized mass-like wall thickening (arrows) in
the right wall of the bladder, however, high-attenuation fluid
collection (arrowheads) is seen in the perivesical space indicating
perivesical hematoma. Perivesical hematoma is very unusual finding
in bladder carcinoma.
In hemorrhagic cystitis, the bladder may rupture after clot evacuation
(3). In children, this condition has been reported as "pseudotumoral
cystitis"
(4,5). According to Friedman (4), pseudotumoral cystitis is an
uncommon inflammatory condition, which may masquerade as a bladder
tumor in children. There are a variety of clinical presentations
for this condition including hematuria, dysuria, infection, and
obstruction. Reported causative factors include infection (bacterial,
fungal, and parasitic) and allergy. Other inflammatory conditions
mimicking bladder tumor that should be considered in the differential
diagnosis include cystitis glandularis, cystitis cystica, and
eosinophilic cystitis (6-8).
Diagnosis
Hemorrhagic cystitis
References
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