This case study presents a 30-year old male patient with a history of diabetes mellitus who presented with pneumaturia, abdominal pain, and nausea. Imaging revealed abnormal bladder wall thickening containing air, consistent with a diagnosis of emphysematous cystitis. Emphysematous cystitis is a rare bladder infection characterized by gas in the bladder wall and/or lumen, often caused by gas-forming bacteria or fungi and seen in diabetic patients. The patient was started on IV fluids, antibiotics including vancomycin and cefepime, and a foley catheter to treat the condition.

1. Case study of Emphysematous cystitis:-
Presented to:
Sir Ahmed
Presented by:
Kiran Ahsan

2. Cystitis:-
• Cystitis is an inflammation of the bladder.
• The cause of cystitis is a urinary tract infection (UTI). A UTI happens
when bacteria enter the bladder or urethra and begin to multiply.
• Bacterial cystitis. Bacterial cystitis occurs when bacteria enter your
urethra or bladder and cause an infection. ...
• Drug-induced cystitis. ...
• Radiation cystitis. ...
• Foreign body cystitis. ...
• Chemical cystitis. ...
• Cystitis associated with other conditions.

3. Emphysematous cystitis:-
• Emphysematous cystitis is a disease characterized by the
presence of gas in the bladder wall and/or lumen.It is often
caused by gas-producing pathogens such as by gas-forming
bacteria , fungi or gram negative bacteria. Most commonly by
Escherichia coli .
• The primary risk factor is diabetes mellitus.

4. Signs and symptoms:-
• Air in the bladder wall
• Severe abdominal pain
• Weakness
• Dark urine
• Dysuria, fever,
• Vomiting
• Increased urinary frequency,
• Bacteria in the urine.

5. DIAGNOSIS:-
• On Ultrasound:-
• Bladder wall thickening, with the gas appearing as small
echogenic foci located within the bladder wall and often within
the bladder lumen and exhibiting dirty posterior acoustic
shadowing.
• On plain radiograph:-
• Intraluminal gas will be seen as a gas-fluid level that changes
with patient position, and, when adjacent to the non-dependent
mucosal surface, may have a cobblestone or “beaded necklace”
appearance.

6. ON CT SCAN:-
• Abnormal bladder wall thickening that contained air
• Portal venous phase scan which shows Gross gas in the bladder
wall. Contrast filling pseudo-diverticula within the bladder
wall.

7. Case presentation :-
Patient’s Information:
Name:
XYZ
Age:
30 Years
Gender:
Male

8. Physicaly exam:-
• Blood pressure of 173/80 mmHg
• A body temperature of 36.6 degrees Celsius
• Respiratory rate of 20/min
• Pulse rate of 100/min

9. Patient’s Complaint and history:-
• Pneumaturia
• Vomiting
• Nausea
• Abdominal pain
• Diaphoresis, chills, and burning with urination
• Dysuria and Bubbles in her urine
• Pain was 10 (on a scale of 1-10)
• Past medical history of diabetes mellitus. .

10. Diagnosis:-
• At first Blood and Urine test ,Abdominal X-ray , Ultrasound
then Computed tomography

11. Urine and blood test:-
• Urine analysis was performed, which revealed hematuria, bacteria, and
an elevated leukocyte esterase; this suggested a possible urinary tract
infection.
• Complete cell count revealed a white blood cell (WBC) count of 8.0
cells/mcL,
• Hemoglobin of 15.6 gm/DL, red blood cell (RBC) count of 4.28
cells/mcL, and platelet count of 214,000 cells/mcL.
• Elevated glucose level at 392 mg/dL .

12. Abdominal X-ray demonstrating cubble stone in the pelvis due to gas
formation

13. Bladder wall thickening, with the gas appearing as small echogenic foci located within
the bladder wall and often within the bladder lumen and exhibiting dirty posterior
acoustic shadowing

14. Abdominal CT without contrast ;-
Consent form
• Patient preparation:-
• Pregnacy
• Change into a hospital gown and remove jewelry, eyeglasses
and any metal objects.
• Procedure:-
• Lie on exam table
• Take pillows to maintain your position and remain still during
procedure.
• Table will move quickly through the scanner to determine the
correct starting position for your scans.
• In axial, saggital or in coronal planes.

15. PROTOCOLS:-
• FOV :- 320mm
• Scan mode:- Axial or helical
• Current:- 213mA
• Rotation time:- 1 sec
• IV access:- No
• IV contrast:- No

17. A CT scan of the pelvis and abdomen without contrast indicating
abnormal bladder wall thickening that contained air

19. AXIAL NON CONTRAST:-

20. Treatment:-
• The patient was started on intravenous fluid hydration and
admitted to the hospital.
• The patient was started on vancomycin, cefepime,
metronidazole, and a foley catheter.
• A urine culture was ordered to determine the pathogen and the
appropriate antibiotic regimen.

21. References:-
• https://www.slideshare.net/ahmedesawy543/imaging-cystitis-dr-ahmed-
esawy
• https://radiopaedia.org/cases/emphysematous-cystitis-1?lang=us
• https://www.google.com.pk/search?q=emphysematous+cystitis+on+t1+
weighted&tbm=isch&ved=2ahUKEwiv-
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22. • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840514/#:~:te
xt=Emphysematous%20cystitis%20is%20a%20relatively,diabet
ic%20patients%20with%20unusual%20presentations.
• https://www.cureus.com/articles/33597-an-unusual-case-
presentation-of-emphysematous-cystitis
• https://jmedicalcasereports.biomedcentral.com/articles/10.1186/
s13256-015-0530-y
• https://en.wikipedia.org/wiki/Emphysematous_cystitis#/media/
File:Emphysematous_cystitis_-_X-rax_-_SHF.jpg