Ultrasound findings in urogenital schistosomiasis: a pictorial essay

Abstract

Urogenital schistosomiasis is a parasitic disease caused by S. haematobium which is endemic in tropical and sub-tropical areas but is increasingly diagnosed in temperate non-endemic countries due to migration and international travels. Early identification and treatment of the disease are fundamental to avoid associated severe sequelae such as bladder carcinoma, hydronephrosis leading to kidney failure and reproductive complications. Radiologic imaging, especially through ultrasound examination, has a fundamental role in the assessment of organ damage and follow-up after treatment. Imaging findings of urinary tract schistosomiasis are observed mainly in the ureters and bladder. The kidneys usually appear normal until a late stage of the disease.

Keywords: Bladder; Infection; Kidney; Schistosoma; Ultrasound.

Fig. 1

Vesical parietal thickening (arrow—a) and follow-up US control after 1 month of therapy (b). Image C shows a CT control after therapy. A small tiny calcification of the left bladder wall is still perceptible (arrow)

Fig. 2

US scans in a, b show a focal nodular thickening of the bladder in a young Sub-Saharan man with haematuria (arrows). US follow-up after 3 months (c) and 5 months of therapy

Fig. 3

Ultrasound suprapubic examination of a young man from Africa shows a nodular thickening of the bladder (arrow—a). The US follow-up control after 14 months does not show any parietal alteration (b)

Fig. 4

Trilaminar aspect of the bladder walls (arrows, axial scan a; sagittal scan b) which remains even after vesical emptying (c, d)

Fig. 5

Vesical parietal thickening (arrow—a) and follow-up US control after 4 months of therapy (b)

Fig. 6

US and CT study of the bladder in a 24-year-old male from Senegal: the CT axial image demonstrates better the thin wall calcifications (arrows—a and b). CT follow-up after 20 months revealed a minimal increase in the thickness of parietal calcifications (c)

Fig. 7

US images in a, b show a mild hyperechogenicity of the bladder wall associated with stages 1–2 hydronephrosis (c). CT sagittal reconstruction (d) demonstrates the bladder wall calcifications that extend also to the dilated ureter (arrow). Figure e is a para-coronal CT reconstruction that confirms the hydronephrosis

Fig. 8

Diffuse parietal thickening of the bladder in a young Sub-Saharan man before (a, b) and after 14 months of treatment (c, d)

Fig. 9

US scan in a shows a diffused hyperechogenicity of the bladder wall’s submucosa, confirmed in the CT study (b, c). Axial CT scan highlights also an early hydronephrosis with two big calculi

Fig. 10

US imaging (a) shows stage 2 hydronephrosis of the right kidney, confirmed also with urography (b) in a young male patient from Africa

Fig. 11

US study with transrectal approach demonstrates inflammatory areas (a) with hypervascularisation of the prostate gland (b)

Fig. 12

Examples of prostate parenchymal calcifications (a), granulomatous flogosis (b) and pseudonodular inflammation of the gland (c) due to Schistosoma infection

Fig. 13

a and b show ectasia of the seminal vesicles in two male patients affected by chronic schistosomiasis (arrows)

Fig. 14

Chronic epididymitis in a young male patient: the arrow shows a mild increase in vascularization at the Doppler study. This finding is non-specific but falls within the possible manifestations of genitourinary schistosomiasis