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Year : 2017  |  Volume : 12  |  Issue : 2  |  Page : 159-160

Images: Emphysematous cystitis

Department of Radiodiagnosis, Jawaharlal Nehru Medical College, DMIMS(DU), Wardha, Maharashtra, India

Date of Web Publication8-Sep-2017

Correspondence Address:
Tejas Sadavarte
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_52_17

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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

How to cite this URL:
Phatak S, Sadavarte T, Mishra G, Yadav S, Ali Jiwani M D, Patange N. Images: Emphysematous cystitis. J Datta Meghe Inst Med Sci Univ [serial online] 2017 [cited 2022 Aug 11];12:159-60. Available from: http://www.journaldmims.com/text.asp?2017/12/2/159/214190

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 1: Scanned image showing air in urinary bladder region

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Figure 2: CT Scanned image showing intraluminal air and air in urinary bladder

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Figure 3: CT Scanned image showing air in the urinary bladder wall

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  References Top

Grayson DE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: A pictorial review. Radiographics 2002;22:543-61.  Back to cited text no. 1
Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: Illustrative case report and review of the literature. Medicine (Baltimore) 2007;86:47-53.  Back to cited text no. 2
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.  Back to cited text no. 3
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.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3]


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