MedPix® Patient Chart - Case No: 6465 :: - Review Images

47 yo female with persistent N/V, epigastric pain;

Pt presented in DKA (diabetic ketoacidosis). LFTs and amylase/lipase normal.

- Review Images for PT: 6465

intramural bladder gas

- Review Images for PT: 6465

infectious emphysematous cystitis
bladder instrumentation or surgery
trauma
enteric fistula (colo-vesicle)

- Review Images for PT: 6465

Dx: Emphysematous Cystitis

Dx Confirmed by:

- Read

The diagnosis is confirmed by the unique imaging appearance.

Treatment of emphysematous cystitis involves early broad spectrum antibiotics, drainage of the bladder, and management of hyperglycemia if present.

Prognosis in patients diagnosed and treated early in the disease process is usually good.The development of emphysematous ureteritis, nephritis, or adrenalitis portends a poor prognosis.

Emphysematous cystitis is a rare entity (in 2001, a researcher reported his was only the 166th case in medical literature). Typical patients are immunocompromised or elderly and debilitated, and 50% of cases are seen in diabetics.

Patients may present with anything from no symptoms to an acute abdomen. Pneumaturia is rare, since the gas is within the bladder wall. Prevalence in females is twice that in males. Often associated with urinary stasis, and growth of gas forming organisms (most commonly E. coli, but others include Enterobacter aerogenes, Proteus mirabilis, Staphylococcus aureus, streptococci. Clostridium perfrigens, and Candida albicans).

Plain abdominal radiographs are generally sufficient to confirm the diagnosis.

This disease is often not suspected until discovered on the abdominal radiograph. Findings include curvilinear gas lucencies throughout the bladder, often described as a "cobblestone" or "beaded necklace" appearance.

Intraluminal gas may ascend the ureters and create an air pyelogram. In rare cases where plain images are negative despite high clinical suspicion, CT may show intramural bladder gas (as in this case).

Emphysematous cystitis is a rare entity (in 2001, a researcher reported his was only the 166th case in medical literature). Typical patients are immunocompromised or elderly and debilitated, and 50% of cases are seen in diabetics. Patients may present with anything from no symptoms to an apparent acute abdomen. Pneumaturia is rare. Prevalence in females is twice that in males. Often associated with urinary stasis, and growth of gas forming organisms (most commonly E. coli, but others include Enterobacter aerogenes, Proteus mirabilis, Staphylococcus aureus, streptococci. Clostridium perfrigens, and Candida albicans).

Plain abdominal radiographs are generally suffiecient to confirm the diagnosis. This disease is often not suspected until discovered on the abdominal radiograph. Findings include curvilinear gas lucencies throughout the bladder, often described as a "cobblestone" or "beaded necklace" appearance. Gas may ascend the ureters and reveal an air pyelogram. In rare cases where plain images are negative despite high clinical suspicion, CT may show intramural bladder gas (as in this case).

This appearance differs from that of bladder gas introduced by trauma, instrumentation, or vesicocolic fistula, where gas is confined to the bladder lumen, and does not exhibit the curvilinear appearance.

Treatment of emphysematous cystitis involves early broad spectrum antibiotics, drainage of the bladder, and management of hyperglycemia if present.

Prognosis in patients diagnosed and treated early in the disease process is usually good.The development of emphysematous ureteritis, nephritis, or adrenalitis portends a poor prognosis.