Sonopath Forum

Cystitis/Hematuria

I would like some help on interpreting an US of a cat’s bladder. He has a hx of urinary tract disease and had a PU about 4 or 5 years ago. In the past month he has been treated for dysuria with 2 different antibiotics. Symptoms resolved and recurred on cessation of antibiotics.

On this most recent bout we were unable to get a sterile sample to culture. Today I took these images, and I think this is sand on the dependent bladder because it moves to the dependent wall regardless of position, but why is it so colorful with the doppler?

THis cat did also have a high eosinophil count. Is it possible that this could be eosinophilic cystitis?

Comments

DrMac

October 10, 2020 at 3:35 pm -

So, the bladder and urethra

So, the bladder and urethra are consistent with chronc cystitis and urethritis with both cystic and urethral sand. There is also pericystic inflammation and mild effusion. Neoplasia is possible, yet less likely. The color flow Doppler is an artifact (not sure why this happens but I see it on calculi as well). These cats often respond initally to antibiotics then recur when antibioics are stopped and often fail to respond to antibiotics usually around the 3rd or 4th time they are administered. It could be eosinophilic cystitis, or the eosinophils just indicate inflammation. UB biopsy and with histopath and tissue C/S are needed for definitive diagnosis. Continued antibiotics may lead to resistance and disruption of UB flora possibly making inflammation worse. Often times these cats have other issues / comobidities (maybe food allergy?, Pandora syndrome). Therapy for FIC suggested which is a trial and error process – environment enrichment, low dose analgesia if indicated, possible dietary therapy, anti-inflammatories if renal function is ok, urinary probiotics, etc.

rlobetti

October 11, 2020 at 3:22 pm -

With the duration of clinical

With the duration of clinical signs, full thickness biopsy of the bladder is needed for a specific diagnosis. With the high eosinophil count, could be dealing with hypereosinophilic syndrome or systemic mastocytosis – what did the spleen look like on ultrasound?. Can consider doing FNA cytologyof the spleen and peripheral lymph nodes. There are also a few isolated reports in the human literature with cystitis/hematuria and hypereosinophilia with complete resolution of the cystitis over time with prednisolone therapy.

jas

October 12, 2020 at 6:05 pm -

Thanks very much for your

Thanks very much for your help. I will give the client these options. We just had a kitty with hypereosinophic syndrome and intestinal masses last week. jas