Emphysematous cystitis: radiological diagnosis of complicated urinary tract infection

Abstract

Emphysematous cystitis is an uncommon condition characterised by the presence of gas in the bladder. It is an infection caused by gas forming organisms, usually in elderly women with a background of diabetes mellitus. The presentation is variable, however with increasing use of imaging more cases are being diagnosed in asymptomatic patients. Routine cross-sectional imaging is not advocated for specific diagnosis but its role in accurate assessment of the severity of the condition cannot be overlooked. As the mode and duration of follow-up in incidentally detected cases has not been addressed in the literature, follow-up should be tailored individually depending upon the severity and response to treatment. We describe two such incidentally detected cases of emphysematous cystitis in elderly diabetic patients and present a review of the literature. The triad of treatment is adequate control of diabetes, antibiotics and bladder drainage. One patient died in the hospital, while the other underwent a flexible cystoscopy 6 weeks later which was normal.

Figure 1

(A) Horizontal CT slice showing gas in the bladder. (B) Coronal CT slice showing air in the bladder. (C) Sagittal CT slice showing air in the bladder.

Figure 2

CT showing scrotal abscess.

Figure 3

Ultrasound scan of the scrotum showing heterogenous and predominantly hypoechoic areas in the left scrotum suggestive of abscess.

Figure 4

(A) Horizontal CT slice showing increased emphysema. (B) Coronal CT slice showing increased emphysema. (C) Sagittal CT slice showing increased emphysema.

Figure 5

CT showing liver abscess.

Figure 6

Incidental emphysematous cystitis.