Cystitis Emphysematous on CT

Abstract

Emphysematous cystitis is a rare form of lower urinary tract infection characterized by the presence of gas in the lumen and/ or bladder wall. The main cause is diabetes, especially in cases of poor balance or bladder neuropathy, but also in cases of immunosuppression. It is secondary to anaerobic glucose metabolism, which leads to the production of CO2. This leads to parietal emphysema by parietal gas dissection, which can spread in severe forms to the peri bladder cellulo-fat space. Not recommended for diagnosis, the abdomen without preparation may find pneumovesia or pelvic hydroaeriosis. Ultrasonography shows parietal bladder air bubbles with shadow cones. The CT scan shows multiple diffuse circumferential air bubbles in the bladder wall without digestive fistula (Figure 1; Figure 2: blues arrows). The germs involved are aerobic and anaerobic, but especially Escherichia Coli and Klebsiella pneumoniae. The prognosis depends on the early diagnosis and antibiotic treatment.