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Bladder

Cystitis

Emphysematous cystitis

Reviewer: Nat Pernick, M.D, PathologyOutlines.com (see Reviewers page)
Revised: 1 July 2011, last major update June 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Rare entity, associated with diabetes, with gas-filled cysts in bladder wall

Epidemiology
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● Median patient age is 66 years, 64% women, 67% had diabetes mellitus (BJU Int 2007;100:17)

Etiology
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● Due to gas forming bacteria (Clostridium perfringes, E. coli, Enterobacter aerogenes), which produce gas-filled cysts in bladder wall
● In one study, E. coli was most commonly isolated organism (J Microbiol Immunol Infect 2009;42:393)
● CO2 may be produced by microorganisms through fermentation of glucose
● There may also be impaired transportation of gas, due to local inflammation or other obstructive process (Braz J Infect Dis 2008;12:552)

Clinical features
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● Associated with diabetes (50% of cases), chronic cystitis, neurogenic bladder, leukemia/lymphoma
● Commonly presents with pneumaturia
● Diagnosed by radiologic evidence of gas in bladder mucosa
● Rare complication is subcutaneous emphysema (Int J Emerg Med 2011;4:26)

Radiologic images
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CT scan shows gas in bladder and bladder wall

CT scan of 77 year old woman without diabetes

Pelvic radiograph demonstrates circumlinear streaks of increased radiolucency representing air

Case reports
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● 62 year old woman with E. coli infection and diabetes (Intern Med 2010;49:1879)

Treatment
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● Antibiotics, relieve bladder obstruction

Micro description
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● Cysts often lined by multinucleated giant cells

End of Bladder > Cystitis > Emphysematous cystitis

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