A rare x-ray image of emphysematous cystitis
Emphysematous cystitis is a rare complication of lower urinary tract infections. It is characterized by the presence of air within the urinary bladder wall and/or the presence of intraluminal air within the bladder. The following case report appears in the journal Urology Case Reports.

A 64-year-old female developed generalized abdominal tenderness on the 21st day of her admission under the general medical and rehabilitation team following a low speed motor vehicle accident. Her background history was significant for Child's C Liver Cirrhosis, Chronic liver failure as a result of alcohol abuse, hypertension and depression with recent ascetic tap performed two days prior.

On initial physical examination she had a GCS of 13 and was haemodynamically stable. Further characterization of the pain identified that it was more localized suprapubically. Physical examination revealed marked suprapubic tenderness.

Bloods revealed an elevated white cell count of 13.5 × 109/L with neutrophils at 10.56 × 109/L and an elevated CRP of 14mg/L. Urinalysis showed 390 leucocytes per high power field and greater than 500 erythrocytes per high power field with bacteria present.

An abdominal x-ray performed revealed gas in an oval distribution projected in the lower pelvis suspicious for emphysematous cystitis. This was confirmed on CT scan. Eventual culture of the urinalysis revealed Klebsiella pneumonia and Proteus mirabilis both sensitive to cephazolin. She was treated with an indwelling catheter for bladder decompression as well as to drain the urinary sepsis and long term IV cephazolin.

She recovered well and was subsequently reviewed in outpatients and had no further urological issues.

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