A case of polypoid and papillary cystitis mimicking an advanced bladder carcinoma with invasion of perivesical fat

Radiologic findings of polypoid pyeloureteritis: a case report

Polypoid pyeloureteritis is a rare benign exophytic mucosal lesion of the renal pelvis and ureter caused by recurrent inflammation. Risk factors include a history of radiation therapy, colovesical fistulas, or calculi. To our knowledge, we present the first documented case of polypoid pyeloureteritis with radiologic, pathologic, and clinical correlation. A 74-year-old male with a history of right papillary renal cell carcinoma status-post nephrectomy and recurrent nephrolithiasis presented for computed tomography urography for carcinoma surveillance. Computed tomography urography revealed urothelial thickening at the left renal pelvis along with small polypoid filling defects in the left renal collecting system at the ureteropelvic junction, as well as a 3mm nonobstructing stone. Biopsy of the lesion confirmed the diagnosis of polypoid pyelitis with ureteritis. Lithotripsy for stone removal was administered at the time of biopsy, and fulguration of the mass was performed. At the time of 1-year follow-up the patient denied any complaints, including urinary symptoms. Imaging was once again remarkable for extensive urothelial thickening of the left renal pelvis and proximal ureter that demonstrated subtle nodularity, consistent with known polypoid pyeloureteritis. Clinical context and pathologic findings should be considered to differentiate benign polypoid lesions from urothelial neoplasms after observing urothelial thickening and filling defects on computed tomography urography. If the lesion is non-neoplastic, fulguration combined with removal of the irritant may serve as an alternative management for surgical excision.

Polypoid Cystitis and Bilateral Hydronephrosis Mimicking Urothelial Carcinoma

Background: Polypoid cystitis is infrequently seen in noncatheterized patients, occasionally posing challenging treatment options. We present a rare case of polypoid cystitis with bilateral upper tract obstruction mimicking a bladder tumor, needing staged endoscopic management. Case Presentation: A 45-year-old Asian man with a bladder tumor presented with lower urinary tract symptoms. Subsequent transurethral resection of bladder tumor histology revealed polypoid cystitis. This had caused intramural edema and obstruction of the distal ureters that were managed with initial local resection, ureteral dilatation with a period of ureteral stenting, and oral steroids. Subsequent intravenous urogram and diuretic renogram showed resolution of obstruction and resolution of hydronephrosis. He also had mixed lower urinary tract symptoms and hematuria managed with combination of solifenacin, finasteride, and tamsulosin. Conclusion: Polypoid cystitis with ureteral obstruction needs to be considered in differentials of a bladder tumor, and management may include a combination of endoscopic resection, ureteral stenting, and in resistant cases oral steroids can be considered to aid resolution of inflammation in the absence of infection.

Infectious and Inflammatory Diseases of the Urinary Tract: Role of MR Imaging

Urinary tract infection (UTI) is among the most common of bacterial infections. Imaging studies are only required in cases of complicated UTIs. Ultrasound remains the first-line imaging method; however, CT is the gold standard for evaluation of UTIs. MR imaging's improved contrast resolution and absence of ionizing radiation may recommend its use for assessment of lower UTIs. Furthermore, MR imaging performs with diagnostic accuracy at least similar to CT in complicated UTIs, except for the identification of calculi and emphysematous pyelonephritis. In this article, the role of MR imaging for the evaluation of infectious and inflammatory disease processes of the urinary tract is reviewed.