The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Lindsey R. Baden, M.D., Editor

Eggshell Calcifications of the Bladder

A B C

A
43-year-old man presented with a 1-month history of dysuria Pankaj Nepal, M.D.
and intermittent hematuria. Similar episodes had occurred several times in Devendra Kumar, M.D.
the 6 months preceding presentation, along with episodes of rectal bleed- Al Wakra Hospital
ing. The physical examination was unremarkable. Laboratory investigations revealed Doha, Qatar
an elevated albumin:creatinine ratio (96 mg of albumin per millimole of creatinine), pankaj-123@live.com
with dysmorphic red cells in the urine. Two urine cultures were sterile. A serum
schistosoma antibody titer was 1:256. Renal ultrasonography revealed mild hydro-
ureteronephrosis. Computed tomography of the abdomen and pelvis without the
administration of contrast material revealed hydroureteronephrosis of the right
ureter and kidney, with faint mural calcification of the ureter (Panel A, white arrow)
and smooth mural calcification of the bladder (Panels A, B, and C, yellow arrows).
There was also calcification of the seminal vesicles (Panel B, red arrow) and the
wall of the rectosigmoid bowel (Panels B and C, white arrows). This pattern of
calcification is typical of chronic genitourinary and gastrointestinal schistosomia-
sis, in which the larvae of the schistosoma parasite are deposited on the walls of
the organs and become calcified. Diagnosis is based on a history of exposure
along with a strong clinical suspicion of infection and the characteristic radio-
graphic findings. Tuberculosis may also cause calcification of the bladder wall and
should be considered in the differential diagnosis.
DOI: 10.1056/NEJMicm1504759
Copyright © 2016 Massachusetts Medical Society.

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