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Pelvis » Urinary Bladder
Emphysematous cystitis
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Author(s) :
Pamela T. Johnson, MD
 
Presentation This 21 year old man developed dysuria in the week following his spinal surgery. ludhiana
 
 
 
Caption: Sagittal sonogram of the urinary bladder.
Description: The sonogram demonstrates bladder wall thickening and hyperechoic foci, due to intramural vs. intraluminal gas.
 
 
 
Caption: Transverse sonogram of the urinary bladder.
Description: This sonogram shows hyperechoic foci,due to gas, within or adjacent to the thickened bladder wall.
 
Differential Diagnosis 1. Emphysematous cystitis 2. Air in the bladder lumen due to fistula with bowel (Crohn's disease, diverticulitis, bowel or bladder tumor) 3. Instrumentation resulting in bladder lumen air. ludhiana     
 
Final Diagnosis Emphysematous cystitis. ludhiana
 
Discussion Emphysematous cystitis is more common in diabetic patients, particularly those with poorly controlled diabetes. Women are affected more commonly than men. Other risk factors include history of urinary tract infections or urinary obstruction and atonic bladder.

Patients present with symptoms of cystitis including hematuria and suprapubic tenderness. They may report pneumaturia. The most common causative organism is E. Coli.

Plain film radiograph, ultrasound or CT will demonstrate gas in the bladder lumen or within the bladder wall, and bladder wall thickening. The gas is actually carbon dioxide which results from the fermentation of urine glucose.

Unlike emphysematous pyelonephritis, this is not necessarily a life threatening condition and does not require cystectomy. The treatment includes control of the diabetes and antibiotics.
 
Case References Tsao JW and Jun SL. Diagnostic Dilemma: Emphysematous Cystitis. Am J Med 110(3) 15 February 2001: 220, 239. ludhiana
 
Technical Details  ludhiana
 
Follow Up  ludhiana
 
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