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| IMAGES IN MEDICINE |
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| Year : 2017 | Volume
: 12
| Issue : 2 | Page : 159-160 |
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Images: Emphysematous cystitis
Suresh Phatak, Tejas Sadavarte, Gaurav Mishra, Sanjaykumar Yadav, MD Ali Jiwani, Neeraj Patange
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, DMIMS(DU), Wardha, Maharashtra, India
| Date of Web Publication | 8-Sep-2017 |
Correspondence Address:
Tejas Sadavarte
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_52_17
Emphysematous cystitis is a rare disease caused by severe urinary tract infection. Imaging findings are discussed with demonstration of classical images. Keywords: Emphysematous cystitis, escherichia coli, urinary bladder
How to cite this article:
Phatak S, Sadavarte T, Mishra G, Yadav S, Ali Jiwani M D, Patange N. Images: Emphysematous cystitis. J Datta Meghe Inst Med Sci Univ 2017;12:159-60 |
Emphysematous cystitis is an uncommon condition characterized by severe infection of the urinary bladder typically leading to gas formation in the bladder wall and lumen. The most commonly involved organism is Escherichia More Details coli, but infection can also be caused by other organisms such as Enterobacter, Staphylococcus, Streptococcus, Proteus, Nocardia, Clostridium and Candida, and Klebsiella.[1] The disease has associations with neurogenic bladder, ureteral catheter placement, vesicoureteric reflux, renal insufficiency, and lower urinary tract obstruction. It has a strong association with type 2 diabetes mellitus in 2/3 of all cases and more common in women.[2] It is hypothesized that the presence of gas-producing organisms in conjunction with high glucose or albumin concentrations (both bacterial substrates) favors the development of emphysematous infection in the urinary tract.[3] Conventional radiography demonstrates curvilinear or mottled areas of increased radiolucency in the region of the urinary bladder separated from more posterior rectal gas. Ultrasonography imaging shows diffuse bladder wall thickening and increased echogenicity. Focal lesions of high-amplitude echoes with posterior dirty acoustic shadowing into lumen may be seen in cases of extensive involvement. Computed tomography (CT) is a highly sensitive examination that allows early detection of intraluminal or intramural gas. It is also useful in evaluating other causes of intraluminal gas such as enteric fistula formation from adjacent bowel carcinoma or inflammatory pathology. CT cystography and barium enema examination or cystoscopy have comparable results in identifying a vesicocolic fistula.[1] Differential diagnosis of gas within urinary tract includes vesicoenteric fistulas from radiation therapy, rectal carcinoma, diverticular disease or Crohn's disease, and iatrogenic causes such as diagnostic or surgical instrumentation and trauma. History, physical examination, and imaging can differentiate etiologic causes satisfactorily. Fistulous tracts and abscesses can be excluded with the help of CT scan [Figure 1], [Figure 2], [Figure 3].[4] | Figure 2: CT Scanned image showing intraluminal air and air in urinary bladder
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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Grayson DE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: A pictorial review. Radiographics 2002;22:543-61.  [ PUBMED] |
| 2. | Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: Illustrative case report and review of the literature. Medicine (Baltimore) 2007;86:47-53. [ PUBMED] |
| 3. | Huang JJ, Chen KW, Ruaan MK. Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection. J Urol 1991;146:148-51. [ PUBMED] |
| 4. | Bobba RK, Arsura EL, Sarna PS, Sawh AK. Emphysematous cystitis: An unusual disease of the genito-urinary system suspected on imaging. Ann Clin Microbiol Antimicrob 2004;3:20. [ PUBMED] |
[Figure 1], [Figure 2], [Figure 3]
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