Imaging findings from a case of bilharziasis in a patient with gross hematuria of several years' duration.

Abstract

A 31-year-old man came to the hospital complaining of gross hematuria. Pelvic computed tomography (CT) showed mild thickening of the anterior wall of the urinary bladder. After injection of contrast material, the inner part of the anterior wall of the urinary bladder was mildly enhanced. Magnetic resonance imaging (MRI) showed that the anterior wall of the urinary bladder had localized thickening. There was a discrete area of hyper-intensity in the lesion on T2-weighted images. Differentiation of the lesion from malignancy was difficult based on the CT and MRI findings. The urologists decided to perform transurethral resection of this lesion. The pathological findings showed inflammatory granulation tissues in the peculiar muscle plate and Schistosoma haematobium eggs. His travel history showed that he had traveled to about 30 nations and had been swimming in a lake in Africa several years ago. He began therapy with praziquantel. MRI has better contrast resolution than CT and so detects findings of inflammatory change better than CT. Although it is difficult to distinguish a tumor from the inflammatory change, MRI nevertheless plays an important role in the diagnosis of patients with continuous hematuria, especially those with a history of travel to Africa and/or the Middle East.