← All patterns
Bladder wall thickening
GUCT / MRI / US
Thickening of the bladder wall, focal or diffuse. Focality, enhancement and clinical context (outflow obstruction, infection) direct the differential.
Differential
Chronic outlet obstruction (trabeculation)
common- •Diffuse smooth/trabeculated wall with diverticula
- •Enlarged prostate; elevated post-void residual
Cystitis
common- •Diffuse circumferential thickening with mucosal enhancement
- •Perivesical stranding; urinary symptoms/infection
Urothelial (transitional cell) carcinoma
common- •Focal enhancing papillary or sessile mass
- •Enhances in early phase; may calcify on surface
- •Painless haematuria, smoker
Neurogenic bladder
less-common- •Trabeculated "pine-cone/Christmas-tree" bladder
- •Spinal cord injury / neurological disease
Schistosomiasis
rare- •Curvilinear mural calcification
- •Endemic exposure; predisposes to squamous carcinoma
Bladder endometriosis
rare- •Posterior dome/wall nodule, T1-bright foci
- •Cyclical dysuria/haematuria in a woman of reproductive age
Key discriminators
- •Focal (tumour) vs diffuse (obstruction/inflammation)
- •Enhancement of a discrete mass
- •Degree of bladder distension at imaging (pseudo-thickening)
- •Mural calcification (schistosomiasis)
- •Clinical setting (obstruction, infection, haematuria)
Work-up / next steps
- 1.Re-image with an adequately distended bladder
- 2.CT urography or multiparametric MRI for focal lesions
- 3.Cystoscopy and biopsy for suspected tumour
- 4.Urinalysis/culture to exclude cystitis
References
- Radiopaedia: Bladder wall thickening.
- Wong-You-Cheong JJ et al. Neoplasms of the urinary bladder. RadioGraphics.
Educational clinical decision support only. This differential does not make a diagnosis, is not a medical device, and must never substitute for interpretation by a qualified radiologist correlated with the full clinical picture and prior imaging.