Pediatric Cyclophosphamide Induced Cystitis

  • Etiology: Seen in 70% of patients given high doses of cyclophsphamide
  • Imaging:
    — Diffuse bladder wall thickening with hyperemia
    — Debris and clots in bladder
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: Severe hemorrhagic cystitis

Radiology Cases of Cyclophosphamide Induced Cystitis

CT of cyclophosphamide induced cystitis
Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the abdomen shows diffuse thickening of the bladder wall and hyperemia of the bladder mucosa.
Transverse (above) and sagittal (below) US of the pelvis shows an extremely thick-walled bladder containing echogenic debris and clots.

CT of cyclophosphamide induced cystitis with a large blood clot in the bladder
Axial CT with contrast of the pelvis (above) shows mild thickening of the wall of the bladder which has a large oval mass within it that has a whorled appearance. Transverse US of the bladder (below) shows a large round echogenic lesion with a whorled appearance located posteriorly in the bladder.

US of pediatric cyclophosphamide induced cystitis
Transverse (above) and sagittal (below) US of the bladder show mild diffuse bladder wall thickening and a large hyperechoic clot within the bladder.