Emphysematous Cystitis

Epidemiology:

 • Usually middle-aged diabetic women

 • Other RF: neurogenic bladder, urinary tract outlet obstruction, chronic UTIs, indwelling urinary catheter and immune compromise

Clinical Signs/Symptoms:

 • Usually presents similarly to uncomplicated cystitis, may have fever/chills, dysuria, urinary frequency, urinary hesitancy. May have pneumaturia, although

PE: 

 • Likely unrevealing. Abdominal or flank tenderness may be present or signs of infection, such as fever.

Pathophysiology:

 • Bacteria fermenting sugar or urinary lactulose producing gas in bladder wall. Usually E. Coli, but can also be enterobacter, clostridium, klebsiella pneumoniae, proteus

Diagnosis:

 • Imaging is needed for diagnosis, specifically CT A/P May consider KUB or abdominal ultrasound as initial imaging in patients with high index of suspicion, such as diabetic patients this is often not reported, not noticed or not present

 • UA and Urine cultures also important

Management:

 • Empiric antibiotics early, may narrow per culture data

 • Early treatment important due to concern for emphysematous pyelonephritis



CMC IM Residency @CMC_IM



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