Urogenital Imaging

Cystitis, emphysematous

a rare form of infectious cystitis characterized by the presence of gas in the bladder wall. Emphysematous cystitis is nearly always associated with diabetes mellitus, because gas in the bladder wall is the result of fermentation of urinary glucose to carbon dioxide, typically by Escherichia coli species. Occasionally, emphysematous cystitis is seen in long-standing outlet obstruction, neurogenic bladder, or bladder diverticulum. Clinically, emphysematous cystitis results in dysuria, haematuria, and pneumaturia. At cystoscopy, the bladder mucosa is red and oedematous, and contains multiple gas-filled blebs that rupture easily.

Conventional radiographs demonstrate irregular streaky lucencies in the bladder wall. Gas may also be seen in the bladder, or tracking proximally into the ureters. Intravenous urography confirms the presence of gas in the bladder, as a horizontal air contrast level on erect films. CT also demonstrates these findings (Fig.1). Ultrasound may detect bladder wall air as intramural echogenic foci with "dirty" shadowing. Emphysematous cystitis is treated with intravenous antibodies and stabilization of the associated diabetic state.

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Fig.1

Axial contrast-enhanced CT section of the pelvis, showing air (arrow) in the bladder wall due to emphysematous cystitis.
Cystitis, emphysematous, Fig.1