Hemorajik sistit

Özet

Hemorajik sistit, mesane mukozasındaki inflamasyonla birlikte hematüriye yol açan; ilaç, radyasyon veya enfeksiyonla ilişkili olabilen bir tablodur. BT, duvar değişikliğini ve mesane içindeki kan pıhtılarını göstererek kanama yükünü ve eşlik eden obstrüksiyonu ortaya koyabilir; duvar kalınlaşması tek başına nedeni kanıtlamaz. Gross hematüri değerlendirmesinde sistoskopi ve üst üriner sistemin kesitsel görüntülemesi önerilir; uygun hastada BT ürografi tercih edilebilir. Pıhtı retansiyona yol açabilir; hemorajik sistit düşünülse bile malignite gibi diğer hematüri nedenleri dışlanmalıdır.

Okuma sırası

1. Mesane duvarı. Pelvis BT’de mesanenin arka duvarındaki yuvarlak dansiteyi kan pıhtısıyla uyumlu olabilecek bir bulgu olarak değerlendir.
2. Mesane lümeni. Lümen içindeki yuvarlak odağın kan pıhtısıyla uyumlu olabileceğini not et; olgu raporunda pelvis BT’de bu görünüm arka duvarda izlenmiştir.
3. Pıhtı-duvar sınırı. Hematürinin kaynağını mesaneyle sınırlamayın; gross hematüri değerlendirmesinde üst üriner sistemi kesitsel görüntülemeyle inceleyin ve sistoskopiyi de değerlendirmeye ekleyin.
4. Mesane duvarı ve perivezikal yağ. Çalışmada ultrasonografiyle hemorajik sistit şiddetinin Droller klinik derecesi, laboratuvar testleri ve endoskopi sonuçlarıyla nasıl karşılaştırıldığını göz önünde bulundur.
5. Mesane boynu ve üst üriner sistem. Mesane içindeki pıhtı yükünü ve olası obstrüktif etkileri değerlendir; hemorajik sistitte kan distal üreteri tıkayarak seyrek olarak hidronefroza yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Pelvis BT’sinde mesane arka duvarında kan pıhtısıyla uyumlu yuvarlak bir dansite görülebilir. Ağır hemorajik sistitin ileri evresinde mesane fibrozisi ve kapasite azalması görülebilir.

BT bulguları

• Hemorajik sistitte mesane duvarında kalınlaşma görülebilir.
• Mesane lümeninde kan pıhtısıyla uyumlu yoğunlukta bir oluşum izlenebilir.
• Büyük hacimli kan veya pıhtı varlığında, mesane lümeninde idrara kıyasla daha yüksek atenüasyonlu alanlar izlenebilir.
• Hemorajik sistitin ileri evresinde mesane fibrozisi ve azalmış mesane kapasitesi görülebilir.
• Perivezikal yağ dokusunda çizgilenme ve inflamatuvar kirlenme.
• Mesane boynuna uzanan pıhtı ile birlikte mesane distansiyonu ve üst üriner sistemde genişleme görülebilir.
• Mesane içi kan pıhtısı, pelvis BT’de arka duvar komşuluğunda yuvarlak dansite olarak görülebilir. Gross hematüri değerlendirmesinde sistoskopi ve üst üriner sistem görüntülemesi önerilir.

Normalde

Mesane içi kan pıhtısı, pelvis BT’de mesanenin arka duvarında yuvarlak dansite olarak görülebilir. Mesane pıhtısının eşlik ettiği gross hematüri değerlendirmesinde sistoskopi ve üst üriner sistem kesitsel görüntülemesi önerilir.

Ayırıcı tanı

Ürotelyal karsinom

hemorajik sistit şüphesinde hematürinin diğer nedenleri arasında malignite de dışlanmalıdır.

Enfeksiyöz sistit, hemorajik sistitin olası nedenleri arasındadır; akut hemorajik sistitte bakteriyel enfeksiyon en sık enfeksiyöz etiyolojidir.

Mesane içi kan pıhtısı, BT’de mesane duvarı komşuluğunda yuvarlak bir yoğunluk odağı olarak görülebilir.

Mesane taşı

belirgin mineral atenüasyonu ve sıklıkla bağımlı yerleşimi vardır; pıhtı gibi yumuşak doku yoğunluğunda tabakalanmaz.

Emfizematöz sistit

lümen havasından ayrı olarak mesane duvarı içinde gaz kabarcıkları veya çizgileriyle tanınır.

Tuzaklar

• Mesanenin yetersiz distansiyonu görüntüleme değerlendirmesini güçleştirebilir; duvarı yorumlarken mesane doluluğunu göz önünde bulundur.
• BT’de mesane duvarı komşuluğundaki yuvarlak yoğunluk odağı kan pıhtısıyla uyumlu olabilir.
• Yaygın hemorajik sistit görünümü maligniteyi dışlamaz; hematüri değerlendirmesinde malignite gibi diğer nedenler de araştırılmalıdır.
• Hemorajik sistitte mesane duvarı kalınlaşması görülebilir; tanıda diğer hematüri nedenlerinin dışlanması gerekir.

Kendini dene

1. Hemodinamik olarak stabilize edilmiş gross hematürili hastada önerilen tanısal değerlendirme hangisidir?

   • İdrar sitolojisi, sistoskopi ve üst üriner sistem kesitsel görüntülemesi; eşlik eden hastalıklar izin veriyorsa tercihen BT ürografi
   • Yalnızca pelvik radyografi
   • Tek seferlik antibiyotik tedavisi ve takip
   • Acil nefrektomi
   Cevabı göster

   İdrar sitolojisi, sistoskopi ve üst üriner sistem kesitsel görüntülemesi; eşlik eden hastalıklar izin veriyorsa tercihen BT ürografi. Stabilizasyon sonrasında gross hematüri değerlendirmesinde idrar sitolojisi, sistoskopi ve üst üriner sistem kesitsel görüntülemesi önerilir; eşlik eden hastalıklar izin veriyorsa BT ürografi tercih edilir.

2. Hemorajik sistit düşünülen gross hematürili hastada dışlanması gereken önemli alternatif nedenlerden biri hangisidir?

   • Üriner sistem malignitesi
   • Reaktif sinüzit
   • Meme kanseri metastazı
   • Akut apandisit
   Cevabı göster

   Üriner sistem malignitesi. S2, hemorajik sistit düşünülse bile hematürinin diğer olası nedenlerinin, özellikle malignitenin dışlanması gerektiğini belirtir.

İlgili konular

• Mesane ürotelyal karsinomu
• Akut sistit

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 23 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Adenovirus Infections in Hematologic Malignancy and Hematopoietic Cell Transplant Recipients: Epidemiology, Diagnosis, and Managementpmc.ncbi.nlm.nih.gov
2. Hemorrhagic Cystitis: Making Rapid and Shrewd Clinical and Surgical Decisions for Improving Patient Outcomespmc.ncbi.nlm.nih.gov
3. Hemorrhagic Cystitis Due to Cephalexin and Review of the Literaturepmc.ncbi.nlm.nih.gov
4. Recent Insights into the Pathogenesis, Diagnostics, and Treatment of BK Virus Infections in Children After Hematopoietic Stem Cell Transplantationpmc.ncbi.nlm.nih.gov
5. The utility of hyperbaric oxygen therapy in post-transplant cyclophosphamide-induced hemorrhagic cystitis: a case report and review of the literaturepmc.ncbi.nlm.nih.gov
6. Literature review of allograft adenovirus nephritis and a case presenting as mass lesions in a transplanted kidney without symptoms of urinary tract infection or acute kidney injury.pubmed.ncbi.nlm.nih.gov
7. Cyclophosphamide-associated enteritis presenting with severe protein-losing enteropathy in granulomatosis with polyangiitis: A case report.pubmed.ncbi.nlm.nih.gov
8. Cytomegalovirus-related hemorrhagic cystitis in an immunocompetent child.pubmed.ncbi.nlm.nih.gov
9. BK virus encephalitis and end-stage renal disease in a child with hematopoietic stem cell transplantation.pubmed.ncbi.nlm.nih.gov
10. Current status and future outlook of ultrasound treatment for prostate cancer.pubmed.ncbi.nlm.nih.gov
11. Urologic oncologic emergencies: a radiologist's guide.pubmed.ncbi.nlm.nih.gov
12. Abdominal complications following hematopoietic stem cell transplantation.pubmed.ncbi.nlm.nih.gov
13. Characteristics of polyomavirus BK (BKPyV) infection in primary human urothelial cells.pubmed.ncbi.nlm.nih.gov
14. Central nervous system mucormycosis in a patient with hematological malignancy: A case report and review of the literature.pubmed.ncbi.nlm.nih.gov
15. A Phase 1 Trial of TPI 287 as a Single Agent and in Combination With Temozolomide in Patients with Refractory or Recurrent Neuroblastoma or Medulloblastoma.pubmed.ncbi.nlm.nih.gov
16. Fabrication of impedimetric sensor based on metallic nanoparticle for the determination of mesna anticancer drug.pubmed.ncbi.nlm.nih.gov
17. Ultrasonography in the diagnosis of hemorrhagic cystitis - a complication of bone marrow transplantation in pediatric oncology patients.pubmed.ncbi.nlm.nih.gov
18. Acute unilateral hydronephrosis in the setting of hemorrhagic cystitis.pubmed.ncbi.nlm.nih.gov
19. Radiation Therapy for Para-Aortic Lymph Node Metastasis from Uterine Cervical Cancer.pubmed.ncbi.nlm.nih.gov
20. PD-1/PD-L1 inhibitor-related cystitis: clinical features, diagnostic exclusion, and outcomes in one definite and seven probable cases with an updated literature review.pubmed.ncbi.nlm.nih.gov
21. Rationale for the Use of 8-Aminoguanine for the Management of Cystitis.pubmed.ncbi.nlm.nih.gov
22. Hemorrhagic Cystitis: Making Rapid and Shrewd Clinical and Surgical Decisions for Improving Patient Outcomes.pubmed.ncbi.nlm.nih.gov
23. The gene mutation pattern of urachal squamous cell carcinoma resembles that of gastrointestinal tumors: a rare case with favorable prognosis following surgery and adjuvant chemotherapy.pubmed.ncbi.nlm.nih.gov
24. Anticoagulation-Amplified Recurrent Esophageal Hemorrhage in Triple-Positive Antiphospholipid Syndrome: The Inescapable Anticoagulation Dilemma.pubmed.ncbi.nlm.nih.gov
25. Albumin Protects Against Cyclophosphamide-Induced Hemorrhagic Cystitis by Scavenging Acrolein and Reactive Oxygen Species.pubmed.ncbi.nlm.nih.gov
26. Hemostatic Efficacy and Clinical Outcomes of Radiotherapy in Older Adult Patients With Advanced Bladder Cancer and Hematuria Unsuitable for Standard Treatment.pubmed.ncbi.nlm.nih.gov
27. BK Polyomavirus-Associated Nephropathy and Hemorrhagic Cystitis in Transplant Recipients-What We Understand and What Remains Unclear.pubmed.ncbi.nlm.nih.gov
28. Patient Reported Outcomes and Treatment-Associated Complications as a Consideration in Selecting Localized Prostate Cancer Management.pubmed.ncbi.nlm.nih.gov
29. Imaging of Bladder Cancer: Standard Applications and Future Trends.pubmed.ncbi.nlm.nih.gov
30. Haematuria: an imaging guide.pubmed.ncbi.nlm.nih.gov
31. Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children.pubmed.ncbi.nlm.nih.gov
32. Inflammatory Disorders of the Central Nervous System Vessels: Narrative Review.pubmed.ncbi.nlm.nih.gov
33. Medical emergencies in pediatric blood & marrow transplant and cellular therapies.pubmed.ncbi.nlm.nih.gov
34. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
35. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
36. Sugar metabolism, an additional virulence factor in enterobacteria.pubmed.ncbi.nlm.nih.gov
37. Diagnostic utility of ultrasonography for thoracic and abdominal bacterial and parasitic diseases in ruminants: a comprehensive overview.pubmed.ncbi.nlm.nih.gov
38. The role of imaging in pelvic exenteration for gynecological cancers.pubmed.ncbi.nlm.nih.gov
39. Chemotherapy-related complications in the kidneys and collecting system: an imaging perspective.pubmed.ncbi.nlm.nih.gov
40. Suspected Urine-Induced Chemical Peritonitis Secondary to Invasive Bladder Cancer: A Case Report.pubmed.ncbi.nlm.nih.gov
41. Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis.pubmed.ncbi.nlm.nih.gov
42. Imaging of acute pelvic pain.pubmed.ncbi.nlm.nih.gov
43. Carboplatin-induced hematuria in a patient with stage I seminoma: a case report.pubmed.ncbi.nlm.nih.gov
44. Pelvic Radiation Disease.pubmed.ncbi.nlm.nih.gov
45. Prevention and management of radiotherapy-related toxicities in gynecological malignancies. Position paper on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology).pubmed.ncbi.nlm.nih.gov
46. Mimics and Pitfalls of Primary Ovarian Malignancy Imaging.pubmed.ncbi.nlm.nih.gov
47. Multidetector CT of expected findings and complications after hysterectomy.pubmed.ncbi.nlm.nih.gov
48. Cross-sectional imaging of complicated urinary infections affecting the lower tract and male genital organs.pubmed.ncbi.nlm.nih.gov
49. Small cell carcinoma in a bladder diverticulum: a rare case report and literature review.pubmed.ncbi.nlm.nih.gov
50. Villous adenoma of the urinary bladder with imaging findings suggestive of enterovesical fistula: A case report.pubmed.ncbi.nlm.nih.gov
51. Arteriovenous Malformation of the Ureter: A Rare Urological Entity Managed With Endoscopic Laser Ablation.pubmed.ncbi.nlm.nih.gov
52. Emphysematous cystitis due to Streptococcus salivarius infection in a patient with a neurogenic bladder.pubmed.ncbi.nlm.nih.gov
53. CT and MRI in Urinary Tract Infections: A Spectrum of Different Imaging Findings.pubmed.ncbi.nlm.nih.gov
54. Complete reversal of the clinical symptoms and image morphology of ketamine cystitis after intravesical hyaluronic acid instillation: A case report.pubmed.ncbi.nlm.nih.gov
55. Open cavotomy for retrieval of inferior vena cava cement embolism after cement-augmented spinal fusion.pubmed.ncbi.nlm.nih.gov
56. Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion.pubmed.ncbi.nlm.nih.gov
57. Upper urinary tract stone characteristics and outcome of retrograde intra renal surgery with laser lithotripsy in a Nigerian tertiary hospital: a retrospective study.pubmed.ncbi.nlm.nih.gov
58. Safety and efficacy of flexible and navigable suction combined with retrograde flexible ureteroscopy in the management of infectious stones.pubmed.ncbi.nlm.nih.gov
59. What to Expect (and What Not) from Dual-Energy CT Imaging Now and in the Future?pubmed.ncbi.nlm.nih.gov
60. A case of emphysematous cystitis with significant quantity and atypical gas distribution on CT.pubmed.ncbi.nlm.nih.gov
61. Emphysematous cystitis treated with targeted antibiotic therapies: a report of two cases.pubmed.ncbi.nlm.nih.gov
62. A rare case of emphysematous cystitis and intravesical fungus balls caused by Candida tropicalis.pubmed.ncbi.nlm.nih.gov
63. The Role of Imaging in Bladder Cancer Diagnosis and Staging.pubmed.ncbi.nlm.nih.gov
64. Bladder tumors in patients initially diagnosed with interstitial cystitis: a ten-year retrospective study.pubmed.ncbi.nlm.nih.gov
65. Sintilimab‑related cystitis/ureteritis in high‑grade endometrial stromal sarcoma: A case report and structured literature review.pubmed.ncbi.nlm.nih.gov
66. Rare Immune-Related Adverse Events (irAEs): Approach to Diagnosis and Management.pubmed.ncbi.nlm.nih.gov
67. Hemorrhagic Cystitis With Bladder Tamponade Associated With <i>Morganella morganii</i> in an Older Patient Without Recent Catheterization.pubmed.ncbi.nlm.nih.gov
68. A Case of Drug-Induced Cystitis Associated With a Multicomponent Herbal Formulation Involving Yokuinin-To.pubmed.ncbi.nlm.nih.gov
69. Management of Inflammatory Myofibroblastic Tumor of Urinary Bladder With Partial Cystectomy: A Case Report.pubmed.ncbi.nlm.nih.gov
70. Upper tract urothelial carcinoma mimicking emphysematous pyelonephritis: a diagnostic challenge case report.pubmed.ncbi.nlm.nih.gov
71. Aggressive prostatic embryonal rhabdomyosarcoma in an adolescent: A case report and short review.pubmed.ncbi.nlm.nih.gov
72. Urinary bladder: normal appearance and mimics of malignancy at CT urography.pubmed.ncbi.nlm.nih.gov
73. Complications and salvage options after laser lithotripsy for a vesical calculus in a tetraplegic patient: a case report.pubmed.ncbi.nlm.nih.gov
74. Modeling of chronic radiation-induced cystitis in mice.pubmed.ncbi.nlm.nih.gov
75. 2012 CUA Abstracts.pubmed.ncbi.nlm.nih.gov
76. Pitfalls and Limitations of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Urinary Bladder Cancer.pubmed.ncbi.nlm.nih.gov
77. Postmenopausal bladder endometriosis without exogenous estrogen: a case report and literature review.pubmed.ncbi.nlm.nih.gov
78. Management of Emphysematous Cystitis in the Intensive Care Unit.pubmed.ncbi.nlm.nih.gov
79. A Case of Partial Cystectomy for Spontaneous Intraperitoneal Rupture of the Bladder Revealed from Hemorrhagic and Septic Shock.pubmed.ncbi.nlm.nih.gov
80. Management of Surgical Complications in Pediatric Kidney Transplantation.pubmed.ncbi.nlm.nih.gov
81. Secondary Amyloidosis of the Urinary Bladder Presenting As Urinary Retention.pubmed.ncbi.nlm.nih.gov
82. Lumpy Skin Disease Virus Infected Calves Showing Multisystemic Vasculitis on Postmortem Examination: A Summary of Six Cases.pubmed.ncbi.nlm.nih.gov
83. Chronic Ketamine Toxicity Involving both Urinary and Hepatobiliary Systems.pubmed.ncbi.nlm.nih.gov
84. Machine learning-based multi-class classification of bladder pathologies using fused 3D CT radiomic and 3D auto-encoder deep features.pubmed.ncbi.nlm.nih.gov
85. Imaging of abdominal and pelvic infections in the cancer patient.pubmed.ncbi.nlm.nih.gov
86. Typical and Atypical Imaging Features of Malignant Lymphoma in the Abdomen and Mimicking Diseases.pubmed.ncbi.nlm.nih.gov
87. Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations.pubmed.ncbi.nlm.nih.gov
88. Disease- and Treatment-related Complication on F-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Oncology Practice: A Pictorial Review.pubmed.ncbi.nlm.nih.gov
89. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
90. Pembrolizumab-Associated Immune-Related Cystitis Mimicking Urothelial Malignancy as Part of a Multi-organ Immune-Related Adverse Event (irAE) Phenotype in a Patient With Metastatic Squamous Cell Lung Cancer: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
91. Rare case of spontaneous extraperitoneal bladder rupture in an elderly bedbound female: a case report.pubmed.ncbi.nlm.nih.gov
92. Emphysematous Cystitis: A Rare Urologic Emergency.pubmed.ncbi.nlm.nih.gov
93. Bladder multilithiasis across different clinical scenarios: Multimodality imaging findings, differential diagnosis, and complication assessment in 4 patients.pubmed.ncbi.nlm.nih.gov
94. Renal fungal ball-two case reports and review of literature.pubmed.ncbi.nlm.nih.gov
95. MDCT of abdominopelvic oncologic emergencies.pubmed.ncbi.nlm.nih.gov
96. The Diagnostic Mirage: Xanthogranulomatous Cholecystitis and the Illusion of Gallbladder Carcinoma.pubmed.ncbi.nlm.nih.gov
97. Massive bleeding from a Bricker ileal conduit during FOLFIRINOX therapy in noncirrhotic portal hypertension: suspected oxaliplatin-associated sinusoidal injury and presumed irinotecan-associated conduit mucositis: a case report.pubmed.ncbi.nlm.nih.gov
98. Slow-flow, high-impact: radiologic features in venous malformations of the female genital tract.pubmed.ncbi.nlm.nih.gov
99. Computed tomography of pediatric abdominal trauma: optimizing utilization and enhancing diagnostic interpretation.pubmed.ncbi.nlm.nih.gov
100. The Development and Pilot Clinical Study of CD147 Targeted Antagonistic Peptide Probe for Tumor Imaging.pubmed.ncbi.nlm.nih.gov
101. Kidney involvement during the course of febrile urinary tract infection.pubmed.ncbi.nlm.nih.gov
102. Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe.pubmed.ncbi.nlm.nih.gov
103. Imaging Tips and Tricks in Management of Renal and Urothelial Malignancies.pubmed.ncbi.nlm.nih.gov
104. MRI of Tumors and Tumor Mimics in the Female Pelvis: Anatomic Pelvic Space-based Approach.pubmed.ncbi.nlm.nih.gov
105. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine.pubmed.ncbi.nlm.nih.gov
106. Case Report: Pediatric Erdheim-Chester disease with cerebral ventricular system infiltration and epiphyseal involvement.pubmed.ncbi.nlm.nih.gov
107. <i>Schistosoma Mansoni</i> and <i>Haematobium</i>: Radiological Diagnostic Clues and Pathophysiology.pubmed.ncbi.nlm.nih.gov
108. Discordance Between Cross-Sectional Imaging and Pathology: A Rare Case of Xanthogranulomatous Inflammation of the Caecum and Appendix.pubmed.ncbi.nlm.nih.gov
109. Synergy of PET and MR imaging in the local and regional staging of bladder cancer.pubmed.ncbi.nlm.nih.gov
110. De novo vesico-acetabular fistula presenting with septic arthritis: Case report and literature review.pubmed.ncbi.nlm.nih.gov
111. Endovascular Interventional Radiology of the Urogenital Tract.pubmed.ncbi.nlm.nih.gov
112. Silk-Fibroin-Based Adhesive Hydrogels: Mechanistic Insights and Biomedical ApplicationsA Review.pubmed.ncbi.nlm.nih.gov
113. Society for Cardiovascular Magnetic Resonance 2024 Cases of SCMR case series.pubmed.ncbi.nlm.nih.gov
114. Diagnostic and Prognostic Non-Invasive Markers in Bladder Cancer.pubmed.ncbi.nlm.nih.gov
115. Intravesical Contrast-Enhanced MRI: A Potential Tool for Bladder Cancer Surveillance and Staging.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.