History: 38 yo male with hematuria. No previous history of urinary symptoms.
Solution: Schistosomiasis
The finding in this case is calcification involving both the wall of the right ureter and the urinary bladder. The differential of this finding includes: Schistomsomiasis, tuberculosis, some forms of cystitis and some neoplasms, particularly TCC. Considering the young age of the patient and the multifocality of the process, a bladder neoplasm is unlikely. There is also no associated wall thickening. Since he has not had any history of previous problems, cystitis is unlikely since it has to be chronic to cause this finding. Therefore, schistosomiasis and tuberculosis remain. The majority of these cases are due to schistosomiasis and if it is tuberculosis, there are often other associated findings. Therefore, schisto is the most likely diagnosis and was the diagnosis in this case.
Schistosomiasis is an infection with a trematode parasite whose lifecycle includes a trip through a snail, the skin, lymphatics and ultimately the bladder/liver/heart/etc. 8% of the world population is infected. It causes symptoms such as frequency, urgency, hematuria, albuminuria, flank pain, and dysuria. It cause linear bladder wall and ureteral calcifications as well as inflammatory pseudopolyps, ureteritis cystica and can result in fistulas and squamous cell carcinoma. Treatment is with an anti-parasitic drug.
The finding in this case is calcification involving both the wall of the right ureter and the urinary bladder. The differential of this finding includes: Schistomsomiasis, tuberculosis, some forms of cystitis and some neoplasms, particularly TCC. Considering the young age of the patient and the multifocality of the process, a bladder neoplasm is unlikely. There is also no associated wall thickening. Since he has not had any history of previous problems, cystitis is unlikely since it has to be chronic to cause this finding. Therefore, schistosomiasis and tuberculosis remain. The majority of these cases are due to schistosomiasis and if it is tuberculosis, there are often other associated findings. Therefore, schisto is the most likely diagnosis and was the diagnosis in this case.
Schistosomiasis is an infection with a trematode parasite whose lifecycle includes a trip through a snail, the skin, lymphatics and ultimately the bladder/liver/heart/etc. 8% of the world population is infected. It causes symptoms such as frequency, urgency, hematuria, albuminuria, flank pain, and dysuria. It cause linear bladder wall and ureteral calcifications as well as inflammatory pseudopolyps, ureteritis cystica and can result in fistulas and squamous cell carcinoma. Treatment is with an anti-parasitic drug.
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