Emphysematous Cystitis With Air Bubbles in the Vena Cava

Abstract

A 76-year-old diabetic woman was referred to our hospital with an episode of high fever and sub-abdominal pain. Computed tomography (CT) of the pelvis revealed gas accumulation within the lumen and wall of the bladder and CT of the abdomen demonstrated bubbles in the inferior vena cava. She recovered by urinary drainage and antibiotic therapy. Urinary culture revealed Escherichia coli. CT after the therapy didn't demonstrate gas accumulation of the bladder and bubbles in the inferior vena cava. Emphysematous urinary tract infections (UTIs) have the high fatality rate, it seems to be a possibility that venous bubbles with emphysematous UTIs contribute to the high fatality rate such as air embolisms. It was suspected that bacterial injury of the bladder wall and high vesical pressure caused by urinary outlet obstruction such as neurogenic bladder lead gas translocation into the venous system. Six previous cases of emphysematous UTIs (three emphysematous cystitis cases and three emphysematous pyelonephritis cases) with venous bubbles have been reported to this day. Our case is seems to be the fourth case report that venous bubbles with emphysematous cystitis was demonstrated.

The Presence of Venous Gas Does Not Affect the Prognosis in Emphysematous Cystitis

“…Some studies have suggested that air embolisms may contribute to the high mortality rate of emphysematous urinary tract infections (8). In previous reports of EC with venous gas, due to suspected air embolism, one patient underwent a lung perfusion scan (7), whereas another underwent hyperbaric oxygen therapy as a preventative measure (6).…”

“…So far, there have only been four reported cases of EC with venous gas. Each case improved with treatment (4,6-8). …”