Emphysematous cystitis: radiological diagnosis of complicated urinary tract infection

Middela, Seshikanth; Green, Euan; Montague, Richard

doi:10.1136/bcr.05.2009.1832

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…Ultrasound scan may show abnormal and thickened bladder wall, but has a low sensitivity; it may be useful in patients who show clinical improvement at follow-up. 9 However, CT is required for a definitive diagnosis and will allow differentiation from other causes. 1,2,6 As observed with emphysematous pyelonephritis, about two-thirds of emphysematous cystitis infections are caused by E. coli; the remaining third are caused by Enterobacter species, Clostridium species, Klebsiella pneumonia, Staphylococcus aureus, or Proteus mirabi.…”

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Emphysematous cystitis: The role of CT imaging and appropriate treatment

Eken

Alma

2013

CUAJ

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Emphysematous cystitis is a relatively rare disease characterized by the presence of gas in the bladder wall and/or lumen. The primary risk factor is diabetes mellitus. Emphysematous cystitis should be considered in cases of urinary tract infections in diabetic patients with unusual presentations. Imaging studies are necessary to detect emphysematous cystitis. Accurate diagnosis of the disease and appropriate treatment typically results in a favourable prognosis and can improve the outcome. We present a case of emphysematous cystitis diagnosed by a computed tomography scan in a diabetic woman with poor glycemic control. IntroductionEmphysematous cystitis is a relatively rare and complicated urinary tract infection (UTI) primarily observed in diabetic middle-aged women. This disease is often characterized by non-specific clinical symptoms, with little or no diagnostic clues. It is defined by the presence of air within the bladder wall and/or the bladder lumen in imaging studies.1 Diabetes mellitus (DM) is the major risk factor of emphysematous cystitis. Other risk factors include neurogenic bladder, urinary tract outlet obstruction, chronic UTIs, indwelling urethral catheters, and immune-deficiency.2 Successful management of the disease and appropriate treatment with broad-spectrum antibiotics usually result in a favourable prognosis. 1,2 Case reportA 65-year-old female was admitted to our department with a 2-day history of fever. She complained of nausea, vomiting and mild right flank pain for 3 hours and symptoms of urgency and dysuria for 7 days; she denied using antibiotics for these symptoms. She had a medical history of DM for 14 years and extracorporeal shock wave lithotripsy (ESWL) for a kidney stone 2 years ago. Despite using oral antidiabetics, she had poor diabetic control (fasting blood glucose was between 250 and 350 mg/dL). She was conscious and interactive during the physical examination, which revealed an axillary temperature of 38.7ºC, arterial blood pressure of 130/70 mmHg, respiratory rate of 22 breaths per minute and oxygen saturation of 97%. There was no guarding or rebound to abdominal palpation, but minimal suprapubic tenderness and right side costovertebral angle tenderness was noted.Laboratory testing revealed the following abnormal results: serum white blood count 22,000/µL; erythrocyte sedimentation rate 60 mm/h; C-reactive protein 30.2 mg/dL; blood urea nitrogen 95 mg/dL; creatinine 2.4 mg/dL; initial blood glucose level 380 mg/dL and HbA1C 9.2%. The urine analysis revealed 60 to 80 red blood cells per field, significant leukocyturia and bacteriuria. Ketones, leukocyte esterase, nitrite and urine sugar were also positive ( Table 1). Because of her kidney stone history and right flank pain, abdominopelvic non-contrast CT was performed; abdominal CT revealed a right kidney stone (Fig. 1), and pelvic images showed the presence of intraluminal gas, diffuse thickening of the bladder wall and gas in the bladder lumen (Fig. 2, Fig. 3). There were no findings of ureteral obstruction or...

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Emphysematous cystitis: The role of CT imaging and appropriate treatment

Eken

Alma

2013

CUAJ

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“…However, emphysematous cystitis was suspected because of strong inflammation localized to the bladder. Although emphysematous cystitis is characterized by cobblestone and beaded-necklace appearance on abdominal X-ray [13] , such findings may not be observed when an indwelling bladder catheter is inserted. Hence, CT is useful for establishing diagnoses, as in this case.…”

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Emphysematous cystitis due to Streptococcus salivarius infection in a patient with a neurogenic bladder

Okada

Ichimura

Iinuma

2022

IDCases

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Streptococcus salivarius ( S. salivarius ) is an oral commensal bacterium that rarely causes disease. Here, we report a case of emphysematous cystitis due to S. salivarius infection in a patient with a neurogenic bladder. A 56-year-old woman was hospitalized and managed for left putamen hemorrhage. Afterward, she developed poor oral intake. Although the patient was afebrile, laboratory test results suggested an inflammatory response. Urinalysis revealed pyuria and hematuria. Abdominal computed tomography revealed a thickened urinary bladder wall and intraluminal gas. Additionally, she was diagnosed with a neurogenic bladder as she had approximately 200 mL of residual urine. The patient was diagnosed with emphysematous cystitis, and S. salivarius was isolated from urine culture specimens. The patient’s condition improved immediately after treatment, which included bladder drainage and administration of appropriate antibiotics. We could not find any report on S. salivarius causing urinary tract infections, such as emphysematous cystitis. Accordingly, we report this case along with a review of the literature.

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“…Physicians may also utilize bladder ultrasounds; however, they have lower sensitivity than CT scans. It is noted that it may be useful for serial monitoring in patients who have demonstrated clinical amelioration [5]. However, the air within the bladder wall or lumen could be attributed to a fistula (most commonly colovesical), trauma, colon carcinoma, or instrumentation -these are all other examples of differential diagnoses that should be considered [6].…”

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An Unusual Case Presentation of Emphysematous Cystitis

Ganji

Malhi

Kouyoumjian

2020

Cureus

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Emphysematous cystitis (EC) is a rare infection characterized by gas formation in the bladder wall. We present an unusual case of emphysematous cystitis of a 37-year-old female patient with pneumaturia, vomiting, nausea and abdominal pain. EC was diagnosed on a computed tomography (CT) scan which demonstrated abnormal bladder wall thickening that contained air. Urinalysis was positive for hematuria, bacteria and an elevated leukocyte esterase which further supported the diagnosis. This patient's atypical symptoms and lack of other risk factors that are commonly seen in patients with EC highlight the need for vigilance when assessing for EC.

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Emphysematous cystitis: radiological diagnosis of complicated urinary tract infection

Cited by 6 publications

References 8 publications

Emphysematous cystitis: The role of CT imaging and appropriate treatment

Emphysematous cystitis: The role of CT imaging and appropriate treatment

Emphysematous cystitis due to Streptococcus salivarius infection in a patient with a neurogenic bladder

An Unusual Case Presentation of Emphysematous Cystitis

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