CT Findings of Irregular Gas-Containing Bladder Nodules Indicate Fungal Balls

Overview

A case report highlights that irregular, gas-containing bladder nodules on CT may indicate bladder fungal balls, a rare cause of urinary obstruction. In a diabetic patient, these nodules were associated with Candida tropicalis infection and emphysematous cystitis, with antifungal therapy alone insufficient to resolve obstruction.

Background

Bladder fungal balls are an uncommon cause of urinary obstruction, often occurring in patients with risk factors such as poorly controlled diabetes. Diagnosis can be challenging due to overlapping imaging features with other conditions like enterovesical fistula or blood clots. Computed tomography (CT) can reveal characteristic findings that aid in identification. Management typically requires both antifungal therapy and procedural removal of obstructing masses.

Data Highlights

Key Findings

• CT showed multiple irregular, mixed-attenuation bladder nodules containing intraluminal gas, consistent with emphysematous cystitis.
• Pathology of expelled masses confirmed fungal hyphae; urine culture grew Candida tropicalis.
• Nodules had a mean attenuation of −170 Hounsfield units, indicating a high gas component.
• After 10 days of antifungal therapy, nodules enlarged and coalesced, causing near-complete bladder lumen obstruction.
• Imaging features can mimic enterovesical fistula or blood clots but absence of fistula tract and fecaluria help differentiate fungal balls.
• Effective management generally requires antifungal treatment combined with procedural removal such as cystoscopic evacuation.

Clinical Implications

Physicians should consider bladder fungal balls in diabetic patients presenting with urinary symptoms and irregular gas-containing bladder nodules on CT. Early recognition is critical as antifungal therapy alone may not resolve obstruction, necessitating procedural intervention. Differentiation from other causes like enterovesical fistula is important to guide appropriate management.

Conclusion

The presence of multiple irregular bladder nodules with emphysematous cystitis on CT should raise suspicion for bladder fungal balls. Combined antifungal and procedural treatment is typically required to resolve obstruction.

References

1. Zhang et al, Medicine, 2024 -- CT Findings May Signal Bladder Fungal Balls