Emphysematous cystitis (EC) is a potentially life-threatening urinary tract infection (UTI) characterized by the presence of gas within the bladder wall and lumen. The extension of gas beyond the bladder wall is rare and indicative of severe disease. We present a case of septic shock secondary to EC with the extension of air through the paraspinal and psoas muscles and into the epidural space of the lumbar spinal canal. This finding of intraspinal air is a rare radiographic phenomenon known as pneumorrhachis (PR).

Mediastinitis is a rare, severe condition associated with increased morbidity and mortality. Mediastinitis, a life-threatening infection, may occur during the postoperative period following cardiovascular surgery. We present a unique case of mediastinitis following a dental procedure in a 47 year old healthy male with a past surgical history of acute type 1 aortic dissection repaired with Dacron tube graft and re-suspension of his aortic valve, 16 months earlier. He was noted to have induration on his right pectoralis muscle and underwent chest Computerized Tomography (CT) scan revealing infectious mediastinitis. His condition improved after CT-guided abscess aspiration and a six-week course of intravenous antibiotics. Mediastinitis may result from an infection extending from the oropharynx inferiorly through deep spaces of the neck as a descending necrotizing mediastinitis. This case suggests that disruption of fascial planes following cardiac surgery may predispose individuals to acquire anterior mediastinitis via a descending pathway long after completion of surgery.

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