Diffuse Bladder Wall Thickening On CT

Diffuse bladder wall thickening is a common finding on CT but one which often does not indicate a specific diagnosis.  Diffuse bladder wall thickening is probably most commonly seen when the bladder is incompletely filled with urine.  The bladder has to be fully distended with urine to say that the bladder wall thickening represents an abnormality.

The most common cause of a thickened bladder I see is from infection.  An infection causes the bladder wall to be inflamed and thickened.    Patients will present with pain, increased urgency to urinate, pain with urination and blood in the urine.  The symptoms can mimic other conditions so a CT scan is sometimes ordered.  A sample of your urine will often be analyzed.

I see diffuse thickening of the bladder in older men when they have an enlarged prostate.  The enlarged prostate narrows the urethra causing increased resistance to urine flow and a thickened bladder wall.   Patients often present with difficulty urinating and urinary retention,  Bladder stones, tumors and urethral abnormalities are some of the other conditions that can increase the resistance to urine flow through the urethra.  Some of these conditions can be diagnosed on CT.

Treatments for cancer such as radiation therapy or chemotherapy can also cause bladder wall thickening.  There can also be blood in the urine.  Fistulas or abnormal communications between organs can happen after radiation. This is more common after radiation therapy to the pelvis for patients who have tumors.

Another condition is neurogenic bladder.  This is a bladder which does not function normally because of injury to the nerves which control urination.  Strokes, multiple sclerosis, Parkinson’s are some of the more common causes.  The bladder can be small and contracted or large.  The bladder wall can be thickened and irregular.  There is often a large amount of urine remaining in the bladder after voiding.

The finding of diffusely thickened bladder therefore has multiple causes.  The most common is simply a bladder which is not fully filled with urine.  When the bladder s thickened, it is important for your doctor to correlate with your history and lab tests.  In difficult cases, a urology doctor can look inside your bladder and take biopsies if needed.

In the acute setting, cystitis or bladder infection is most common.  More chronic causes will often be from known conditions such as treatment for cancer or a condition which resulted in nerve damage.  An elderly man with a diffusely thickened wall will often have an enlarged prostate.

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