Case of possible multiple system atrophy with a characteristic imaging finding of open bladder neck during storage phase as an initial sign

Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment.

International journal of urology : official journal of the Japanese Urological Association. 2017 Aug 15 [Epub ahead of print]

Lu Zhang, Nobuhiro Haga, Soichiro Ogawa, Kanako Matsuoka, Tomoyuki Koguchi, Hidenori Akaihata, Junya Hata, Masao Kataoka, Kei Ishibashi, Yoshiyuki Kojima

Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan.