Eosinophilic cystitis detected with blunt renal trauma

Case contribution: Dr Radhiana Hassan


  • A 43 years old man
  • IVDU, Hep C +ve, PTB +ve (completed treatment 9 years ago)
  • Alleged assaulted in Pusat Serenti
  • Complaint of abdominal pain
  • Clinically tender and guarded abdomen. BP=164/93mmHg, PR=75 bpm and GCS=15/15
  • Multiple laceration wound at scalp region. Skull radiograph shows no fracture.
  • Abdominal radiograph shows no pneumoperitoneum.
  • Ultrasound shows bilateral hydronephrosis with free fluid at perisplenic region
Contrast enhanced CT abdomen in axial plane soft tissue window
CT scan at renal level in axial plane soft tissue window; plain (upper row) and post contrast (lower row)
CT scan reformatted image in coronal plane soft tissue window post contrast

CT scan findings:

  • There is a small laceration at lower pole of left kidney with surrounding perinephric hematoma (yellow arrows). Blood collection is seen tracking inferiorly (red arrows).
  • The laceration is not extending to collection system.
  • No other organ injury is seen.
  • There is bilateral moderate to severe hydronephrosis. Presence of calculi at both renal pelvis (blue arrows)
  • Urinary bladder is underfilled with suspicious wall thickening at left side.
  • Prostate is not enlarged.

Progress of patient:

  • Bilateral RPG shows bilateral moderate to gross hydronephrosis
  • No hydroureter seen
  • Filling defect is seen at both PUJ in keeping with calculi
  • Failed to stent right side, left ureteric stenting was successful
  • Bladder growth is seen at trigone region. Biopsy taken.

HPE findings:

  • Polypoidal tissue covered by 6-7 layers of urothelial cells.
  • The lamina propria show a dense inflammatory cells infiltrate rich in eosinophils
  • Fibrosis and few multinucleated giant cells are seen in lamina propria.
  • No malignancy seen.
  • Interpretation: Eosinophilic cystitis

Diagnosis: Grade II renal injury with underlying eosinophilic cystitis


  • Eosinophilic cystitis is a rare urological disease simulating bladder tumour.
  • The incidence is uncertain and it affects patient of all ages.
  • The etiology of eosinophilic cystitis remains unclear.
  • It is characterized by inflammation, mainly by eosinophils throughout all layers of the bladder wall and fibrosis of the mucusa and muscularis necrosis.
  • The typical manifestations are irritative bladder symptoms and most common cases with large bladder mass simulating bladder carcinoma.
  • Ultrasound and CT scan show diffuse or irregular bladder wall thickening which may be seen as tumour-like lesion. Bilateral upper tract dilatation is seen of different severity. Urography revealed small contracted bladder and hydronephrosis.
  • Because of the rareness of this disease, standardized therapy regimen do not exist.
  • Based on changes in differential reaction to corticosteroid and/or antihistamin, patients were divided into 3 groups
    • Group 1: asymptomatic and no need treatment
    • Group 2: good response and cured by oral corticosteroid and/or antihistamin
    • Group 3: deterioration of symptoms although intense medicine therapy and need surgery
Author: radhianahassan