Radiation and chemotherapy cystitis
 Discussion of Radiation and chemotherapy cystitis
- Severe hemorrhagic cystitis may develop after chemotherapy or irradiation of the bladder.
- In the acute phase of radiation and chemotherapy cystitis, there is a hemorrhagic cystitis secondary to denudation of the urothelium.
- The most severe radiation injuries cause bladder necrosis, incontinence, and fistula formation.
- At histologic analysis, there is cellular atypia, with mild to moderate nuclear pleomorphism. The epithelial proliferation may be so marked as to be confused with invasive cancer in the lamina propria.
- Beyond 1 year, chronic radiation effects result from an obliterative endarteritis in the lamina propria, followed by ischemic changes and interstitial fibrosis.
 Imaging Findings for Radiation and chemotherapy cystitis
- At imaging, there is an abnormal bladder wall with focal or diffuse irregular thickening, spasticity, and decreased distensibility.
- Hypervascularity in the wall and bleeding vessels result in intraluminal clot, visible at US or CT.
- MR imaging may show inflammation and edema as high signal intensity with T2-weighted sequences and can enable the bladder wall to be distinguished from clot.
- At imaging, a small fibrosed bladder with a thick wall and resultant hydronephrosis are seen.
- Calcification is rarely seen.
- Other evidence of previous irradiation includes fatty replacement of the pelvic musculature and widening of the presacral space
- Fistulas may occur and pneumaturia and fecaluria are highly suggestive of a fistula.
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 References for Radiation and chemotherapy cystitis
- Jade J. Wong-You–Cheong, Paula J. Woodward, Maria A. Manning, and Charles J. Davis. From the Archives of the AFIP: Inflammatory and Nonneoplastic Bladder Masses: Radiologic-Pathologic Correlation. RadioGraphics 2006 26: 1847-1868.