Differential Diagnosis for Thick Bladder Wall on CAT Scan with Elevated White Count and No Urinary Signs of Infection on Urinalysis

• Single Most Likely Diagnosis
  • Chronic cystitis or interstitial cystitis: These conditions can cause a thickened bladder wall due to chronic inflammation, and the absence of urinary signs of infection does not rule them out, especially if the infection is not bacterial or if the urinalysis was not sensitive enough to detect the infection.
• Other Likely Diagnoses
  • Bladder cancer: A thickened bladder wall can be a sign of bladder cancer, especially in older adults or those with risk factors such as smoking. The elevated white count could indicate a systemic response to the cancer.
  • Neurogenic bladder: This condition, often due to neurological disorders affecting bladder control, can lead to a thickened bladder wall due to chronic overdistension or underdistension.
  • Cytoxan or radiation cystitis: Previous treatments for cancer, such as cyclophosphamide (Cytoxan) or radiation therapy to the pelvic area, can cause a thickened bladder wall.
• Do Not Miss Diagnoses
  • Emphysematous cystitis: Although less common, this is a serious infection of the bladder where gas is produced in the bladder wall, which can be life-threatening if not promptly treated. The absence of typical urinary infection signs does not rule it out.
  • Septic shock from a urinary source: Even without typical signs of urinary infection, a urinary source of sepsis should be considered, especially with an elevated white count, as it can be life-threatening.
• Rare Diagnoses
  • Eosinophilic cystitis: A rare condition characterized by an eosinophilic infiltration of the bladder wall, which can cause a thickened appearance on imaging.
  • Malacoplakia: A rare inflammatory condition that can affect the bladder and cause thickening of the bladder wall, often associated with chronic infection.
  • Schistosomiasis: In endemic areas, this parasitic infection can cause bladder wall thickening and should be considered in patients with appropriate travel or exposure history.