Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. 1031 GENITOURINARY IMAGING Haytham M. Shebel, MD • Khaled M. Elsayes, MD • Heba M. Abou El Atta, MBBCh, PhD •Yehia M. Elguindy, MBBCh • Tarek A. El-Diasty, MD Genitourinary schistosomiasis is produced by Schistosoma haemato- bium, a species of fluke that is endemic to Africa and the Middle East, and causes substantial morbidity and mortality in those regions. It also may be seen elsewhere, as a result of travel or immigration. S haemato- bium, one of the five fluke species that account for most human cases of schistosomiasis, is the only species that infects the genitourinary system, where it may lead to a wide spectrum of clinical symptoms and signs. In the early stages, it primarily involves the bladder and ure- ters; later, the kidneys and genital organs are involved. It rarely infects the colon or lungs. A definitive diagnosis of genitourinary schistoso- miasis is based on findings of parasite ova at microscopic urinalysis. Clinical manifestations and radiologic imaging features also may be suggestive of the disease, even at an early stage: Hematuria, dysuria, and hemospermia, early clinical signs of an established S haematobium infection, appear within 3 months after infection. At imaging, fine ure- teral calcifications that appear as a line or parallel lines on abdomino- pelvic radiographs and as a circular pattern on axial images from com- puted tomography (CT) are considered pathognomonic of early-stage schistosomiasis. Ureteritis, pyelitis, and cystitis cystica, conditions that are characterized by air bubble–like filling defects representing ova de- posited in the ureter, kidney, and bladder, respectively, may be seen at intravenous urography, intravenous ureteropyelography, and CT urog- raphy. Coarse calcification, fibrosis, and strictures are signs of chronic or late-stage schistosomiasis. Such changes may be especially severe in the bladder, creating a predisposition to squamous cell carcinoma. Genital involvement, which occurs more often in men than in women, predominantly affects the prostate and seminal vesicles. © RSNA, 2012 • radiographics.rsna.org Genitourinary Schisto- somiasis: Life Cycle and Radiologic-Pathologic Findings 1 ONLINE-ONLY CME See www.rsna .org/education /rg_cme.html LEARNING OBJECTIVES After completing this journal-based CME activity, participants will be able to: ■ Describe the pathogenesis of genitourinary schis- tosomiasis. ■ Recognize the clin- ical manifestations of genitourinary schis- tosomiasis. ■ Identify imaging features suggestive or indicative of geni- tourinary schistoso- miasis. RadioGraphics 2012; 32:1031–1046 • Published online 10.1148/rg.324115162 • Content Codes: 1 From the Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt (H.M.S., H.M.A., T.A.E.); and De- partment of Radiology, University of Texas M.D. Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., Y.M.E.). Presented as an education exhibit at the 2010 RSNA Annual Meeting. Received September 16, 2011; revision requested October 12 and received December 20; ac- cepted January 10, 2012. For this journal-based CME activity, the authors, editor, and reviewers have no relevant relationships to disclose. Address correspondence to K.M.E. (e-mail: [email protected]). © RSNA, 2012
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