1
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Bondugula HR, Belum Reddy V, Mallavalli S, Gavvala M. Emphysematous vaginitis in a gravid woman. BMJ Case Rep 2024; 17:e257778. [PMID: 38290981 PMCID: PMC10828860 DOI: 10.1136/bcr-2023-257778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
A primigravida in her late 20s presented to the obstetrics and gynaecology department in labour. On per speculum examination, multiple cystic lesions, 1-5 mm in size were observed occupying the anterior, posterior and lateral vaginal walls. Vaginal wet mount was normal and vaginal cultures were negative. Biopsy findings were consistent with emphysematous vaginitis. Vaginitis emphysematosa is a rare, benign self-limiting condition that presents with multiple, air-filled cysts in the vaginal or ectocervical mucosa. This condition is seen in both gravid and non gravid women, usually associated with a Trichomonas or Gardnerella infection.
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Affiliation(s)
- Harshita Reddy Bondugula
- Department of Dermatology, Venereology and Leprosy, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
| | - Vinila Belum Reddy
- Department of Pathology, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
| | - Samhitha Mallavalli
- Department of Dermatology, Venereology and Leprosy, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
| | - Manmohan Gavvala
- Department of Dermatology, Venereology and Leprosy, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
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2
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Wathanavasin W, Susantitaphong P. A case of emphysematous cystitis complicated by unilateral hydronephrosis and septicemia: nephrology picture. J Nephrol 2023; 36:301-302. [PMID: 36098881 PMCID: PMC9469812 DOI: 10.1007/s40620-022-01452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Wannasit Wathanavasin
- Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, 8 Tok Road, Bang Kho Laem, Bangkok, 10120, Thailand.
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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3
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Antimicrobial Peptide LCN2 Inhibited Uropathogenic Escherichia coli Infection in Bladder Cells in a High-Glucose Environment through JAK/STAT Signaling Pathway. Int J Mol Sci 2022; 23:ijms232415763. [PMID: 36555403 PMCID: PMC9779052 DOI: 10.3390/ijms232415763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
JAK/STAT plays a key role in regulating uropathogenic Escherichia coli (UPEC) infection in urothelial cells, probably via antimicrobial peptide (AMP) production, in diabetic patients with urinary tract infections. Whether multiple pathways regulate AMPs, especially lipid-carrying protein-2 (LCN2), to achieve a vital effect is unknown. We investigated the effects of an LCN2 pretreatment on the regulation of the JAK/STAT pathway in a high-glucose environment using a bladder cell model with GFP-UPEC and phycoerythrin-labeled TLR-4, STAT1, and STAT3. Pretreatment with 5 or 25 μg/mL LCN2 for 24 h dose-dependently suppressed UPEC infections in bladder cells. TLR-4, STAT1, and STAT3 expression were dose-dependently downregulated after LCN2 pretreatment. The LCN2-mediated alleviation of UPEC infection in a high-glucose environment downregulated TLR-4 and the JAK/STAT transduction pathway and decreased the UPEC-induced secretion of exogenous inflammatory interleukin (IL)-6 and IL-8. Our study provides evidence that LCN2 can alleviate UPEC infection in bladder epithelial cells by decreasing JAK/STAT pathway activation in a high-glucose environment. LCN2 dose-dependently inhibits UPEC infection via TLR-4 expression and JAK/STAT pathway modulation. These findings may provide a rationale for targeting LCN2/TLR-4/JAK/STAT regulation in bacterial cystitis treatment. Further studies should explore specific mechanisms by which the LCN2, TLR-4, and JAK/STAT pathways participate in UPEC-induced inflammation to facilitate the development of effective therapies for cystitis.
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A Complex Case of Emphysematous Cystitis in a Peritoneal Dialysis Patient. Case Rep Nephrol 2021; 2021:8343022. [PMID: 34306777 PMCID: PMC8282390 DOI: 10.1155/2021/8343022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022] Open
Abstract
Emphysematous cystitis (EC) is a relatively rare condition characterized by gas formation in the bladder wall and/or lumen. We report a case of emphysematous cystitis with a bladder perforation in an 84-year-old male on peritoneal dialysis who presented with fever, dysuria, hematuria, and hypotension. Gas in the bladder wall, as well as a small perforation in the roof of the urinary bladder, was seen on the abdominal CT scan. The causative organism identified was Escherichia coli. The patient recovered with broad-spectrum antibiotics along with bladder irrigation and drainage. After initial bladder washouts, peritoneal dialysis was continued with close monitoring. Early antibiotic therapy and a conservative approach to the management of small intraperitoneal bladder perforations were effective in this patient. Peritoneal dialysis was uninterrupted for the duration of the admission and after discharge.
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5
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Taylor MM, Li Z, Jones SA. Emphysematous cystitis in chronic kidney disease. Intern Med J 2021; 51:995-996. [PMID: 34155766 DOI: 10.1111/imj.15365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Megan M Taylor
- Department of Nephrology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Zuo Li
- Department of Nephrology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Scott A Jones
- Department of Nephrology, John Hunter Hospital, Newcastle, New South Wales, Australia
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6
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Nepal P, Ojili V, Kumar S, Kumar D, Nagar A. Imaging spectrum of common and rare infections affecting the lower genitourinary tract. Abdom Radiol (NY) 2021; 46:2665-2682. [PMID: 33388810 DOI: 10.1007/s00261-020-02889-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
In this review, we will discuss the imaging findings of common as well as uncommon lower genitourinary tract infections. For both clinicians and radiologists, it is imperative to understand etiopathogenesis, epidemiological information, clinical presentation, imaging findings and management options of such conditions. Knowledge of salient imaging features of these infections is of utmost importance because prompt recognition enables appropriate management.
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7
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Choi J, Choi SK, Lee SH, Yoo KH. Clinical Outcomes and Risk Factor Analysis of Patients Presenting with Emphysematous Cystitis: A 15-Year Retrospective Multicenter Study. ACTA ACUST UNITED AC 2021; 57:medicina57060531. [PMID: 34073208 PMCID: PMC8229240 DOI: 10.3390/medicina57060531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: To investigate the risk factors for emphysematous cystitis (EC) compared to those of acute cystitis (AC) to increase clinicians awareness of the possibility for the aggravation of patient status. Materials and methods: We retrospectively reviewed a total of 54 patients who were hospitalized with a diagnosis of EC by abdominal computed tomography (CT) scan from 2006 to 2020. The control group included 92 patients who were hospitalized for the treatment of AC in the same period. We sought to identify the clinical features and predisposing diseases, such as age, sex, diabetes mellitus (DM), hypertension (HTN), cerebrovascular accident (CVA), chronic kidney disease (CKD), neurogenic bladder (NB), history of urinary tract infection (UTI), and emphysematous pyelonephritis (EPN), that were associated with the development of EC. Results: The median (interquartile range (IQR)) age of the patients with EC was older than that of the patients with AC (78.5 (15.3) years (range: 52-100) vs. 70.0 (26.5) years (range: 28-97 years)). Sepsis and mortality occurred only in the EC group (48.1% and 11.1%, respectively). The univariate analysis of predisposing factors revealed that age, DM, HTN, CVA, CKD, and NB were significantly associated with EC. In the multivariate analysis, DM (OR, 6.251; 95% CI, 2.254-17.250; p < 0.001), CKD (OR, 18.439; 95% CI, 3.421-99.404; p = 0.001), NB (OR, 7.374; 95% CI, 1.993-27.285; p = 0.003) were associated with EC. Conclusions: The results of this study revealed that DM, CKD, and NB were significant risk factors for EC. The tendency toward sepsis and high mortality underscore the need for careful observation while treating patients with EC with the risk noted above.
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Affiliation(s)
- Jeonghyouk Choi
- Department of Urology, College of Medicine, Kyung Hee University, Seoul 02447, Korea; (J.C.); (S.-H.L.)
| | - Seung-Kwon Choi
- Department of Urology, Seoul Medical Center, Seoul 02053, Korea;
| | - Sang-Hyub Lee
- Department of Urology, College of Medicine, Kyung Hee University, Seoul 02447, Korea; (J.C.); (S.-H.L.)
| | - Koo-Han Yoo
- Department of Urology, College of Medicine, Kyung Hee University, Seoul 02447, Korea; (J.C.); (S.-H.L.)
- Correspondence:
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8
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Gas Where It Shouldn't Be! Imaging Spectrum of Emphysematous Infections in the Abdomen and Pelvis. AJR Am J Roentgenol 2021; 216:812-823. [DOI: 10.2214/ajr.20.23545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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9
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Abstract
Emphysematous cystitis is a relatively rare and potentially life-threatening condition characterized by the collection of gas in the bladder wall and lumen due to infection caused by gas-forming organisms. Imaging studies are necessary to detect emphysematous cystitis. The management consists of broad-spectrum antibiotics, strict glycemic control, and bladder drainage. Complications may arise in some cases, requiring surgical treatment. We present a case of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae emphysematous cystitis in a known diabetic.
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Affiliation(s)
- Oluwadamilola A Adeyemi
- Department of Medicine, Section of Infectious Diseases, Swedish Hospital - NorthShore University HealthSystem, Chicago, USA.,Department of Medicine, Section of infectious Diseases, Northwestern Medicine Lake Forest Hospital, Lake Forest, USA
| | - John P Flaherty
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, USA
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10
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Hazarika S, Venkataramanan R, Das T, Venkataramanan A, Deuri S, Lohchab S, Rongpipi T, Agarwala A. Acute Renal Infection in Adult, Part 2: Emphysematous Urinary Tract Infection—What the Radiologist Needs to Know. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0039-3400338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractRenal emphysema, as described by Kelly and MacCallum in 1898, refers to the spontaneous generation of gas within the renal parenchyma and surrounding tissues. Since its initial description, it has become apparent that the spectrum of radiologically visible renal and perirenal gas includes three distinct clinical entities: (1) emphysematous pyelonephritis, a necrotizing infection associated with gas formation in the renal parenchyma, (2) emphysematous pyelitis, in which gas is confined to the renal pelvis and calyces, and (3) gas-forming perinephric abscess. In this article, we will review gas-forming infections of the urinary system in terms of radiological features, clinical manifestations, predisposing factors, and appropriate management guidelines.
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Affiliation(s)
- Suman Hazarika
- Department of Radiology, Apollo Hospitals, Guwahati, India
| | | | - Tonmoy Das
- Department of Nephrology, Apollo Hospitals, Guwahati, India
| | | | - Sukanya Deuri
- Department of Radiology, Apollo Hospitals, Guwahati, India
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11
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Sharma J, Singhal J. A child with urosepsis and a bladder with a halo: Answers. Pediatr Nephrol 2020; 35:75-76. [PMID: 31420729 DOI: 10.1007/s00467-019-04324-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Jyoti Sharma
- Pediatric Nephrology, KEM Hospital, Sardar Moodliar Road, Pune, Maharashtra, 411011, India.
| | - Jyoti Singhal
- Pediatric Nephrology, KEM Hospital, Sardar Moodliar Road, Pune, Maharashtra, 411011, India
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12
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Dorsch R, Teichmann-Knorrn S, Sjetne Lund H. Urinary tract infection and subclinical bacteriuria in cats: A clinical update. J Feline Med Surg 2019; 21:1023-1038. [PMID: 31601143 PMCID: PMC6826873 DOI: 10.1177/1098612x19880435] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PRACTICAL RELEVANCE Urinary tract infection (UTI) is an important cause of feline lower urinary tract disease (FLUTD), particularly in female cats older than 10 years of age. In addition to cats with typical clinical signs of FLUTD or upper UTI, many cats have subclinical bacteriuria, but the clinical relevance of this is currently uncertain. UTIs are one of the most important indications for antimicrobial use in veterinary medicine and contribute to the development of antimicrobial resistance. Adherence to treatment guidelines and confinement to a few first-line antimicrobial agents is imperative to avoid further deterioration of the antimicrobial resistance situation. The decision to treat with antimicrobials should be based on the presence of clinical signs, and/or concurrent diseases, and the results of urine culture and susceptibility testing. CLINICAL CHALLENGES Distinguishing between cats with bacterial cystitis, and those with idiopathic cystitis and concurrent clinical or subclinical bacteriuria, is challenging, as clinical signs and urinalysis results may be identical. Optimal treatment of subclinical bacteriuria requires clarification as there is currently no evidence that demonstrates a beneficial effect of routine treatment. Management of recurrent UTIs remains a challenge as evidence for most alternatives used for prevention in cats is mainly anecdotal, and no preventive treatment modality is currently recommended. EVIDENCE BASE This review draws on an extensive literature base in veterinary and human medicine, including the recently updated guidelines of the International Society for Companion Animal Infectious Diseases for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Where published evidence is lacking, the authors describe their own approach; notably, for the bacteriuric cat with chronic kidney disease.
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Affiliation(s)
- Roswitha Dorsch
- Clinic of Small Animal Medicine, LMU Munich, Veterinärstrasse 13, 80539 Munich, Germany
| | | | - Heidi Sjetne Lund
- Small Animal Section, Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO Box 369 Sentrum, 0102 Oslo, Norway
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13
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Seifert D, Jaganjac S. Uncommon diagnosis of an emphysematous cystitis: A case report. SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-24215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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14
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Chen YC, Chen HW, Juan YS, Wu WJ, Tsai CC. Re: Gaseous bladder tamponade secondary to emphysematous cystitis. Int Braz J Urol 2018; 44:653-654. [PMID: 29570258 PMCID: PMC5996811 DOI: 10.1590/s1677-5538.ibju.2017.0701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 12/25/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yu-Chen Chen
- Kaohsiung Medical University, Taiwan; Kaohsiung Medical University, Taiwan
| | - Hao-Wei Chen
- Kaohsiung Medical University, Taiwan; Kaohsiung Medical University, Taiwan
| | | | - Wen-Jeng Wu
- Kaohsiung Municipal Ta-Tung Hospital, Taiwan
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15
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Liu TH, Lee WJ. Elderly Female with Low Abdominal Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- TH Liu
- E-Da Hospital, Department of Emergency Medicine, I-Shou University, Kaohsiung, Taiwan
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16
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Wan CK, Tang CL, Tsui SH, Tong HK. A Case of Emphysematous Cystitis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790801500305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Emphysematous cystitis (EC) is an uncommon but potentially life-threatening urinary tract infection. Diagnostic difficulty exists because of the variable presentations. We report the case of a 73-year-old woman who presented with diarrhoea and malaise, and emphysematous cystitis was revealed on the abdominal X-ray. As she was treated for EC, the diarrhoea and the radiographic abnormalities of EC also resolved. The evaluation and management of this complicated urinary tract infection are discussed.
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17
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Yang Z, Sheng C. Gas surrounding the urinary bladder in emphysematous cystitis. Int Braz J Urol 2017; 43:1190-1191. [PMID: 28537703 PMCID: PMC5734085 DOI: 10.1590/s1677-5538.ibju.2016.0555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/27/2016] [Indexed: 11/25/2022] Open
Abstract
We report a rare case of emphysematous cystitis in a 66-year-old woman with a history of diabetes mellitus. The predisposition of diabetes mellitus and infection of gas-forming bacteria is considered to precede the manifestation of emphysematous cystitis. The present recommended diagnosis test is computed tomography, which have definite value in the evaluation of gas accumulation in bladder wall, or an air-fluid level in bladder.
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Affiliation(s)
- Zhenyu Yang
- Department of Urology, Pudong New Area People's Hospital, Shanghai, China
| | - Chang Sheng
- Department of Urology, Pudong New Area People's Hospital, Shanghai, China
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18
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Cistitis enfisematosa y agudización infecciosa de la EPOC. Un hallazgo altamente infrecuente. Arch Bronconeumol 2017; 53:406-407. [DOI: 10.1016/j.arbres.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022]
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19
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Bandari J, Yecies TS, Jackman S. Severe emphysematous cystitis: Images in urology. Can Urol Assoc J 2016; 9:371. [PMID: 26834888 DOI: 10.5489/cuaj.3254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Todd Samuel Yecies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Stephen Jackman
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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20
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Kim SR, Dimitriou D, Nam U, Park YG, Choi SW, Seo KB, Kim HJ, Nam KW. Emphysematous Cystitis Found Incidentally in a Patient Undergoing Hip Arthroplasty: A Case Report. JBJS Case Connect 2015; 5:e83. [PMID: 29252593 DOI: 10.2106/jbjs.cc.o.00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Emphysematous cystitis is a rare, complicated urinary tract infection that is potentially life-threatening if left untreated. We present the case of an eighty-one-year-old woman with left hip pain from a low-energy fall with no associated urinary symptoms. Pelvic computed tomography revealed a left femoral neck fracture and an air-fluid level in the bladder. Bipolar hemiarthroplasty was delayed for three weeks to allow for the potentially serious urinary tract infection to resolve. CONCLUSION Increased awareness is required for early diagnosis and treatment of asymptomatic emphysematous cystitis in a patient presenting with musculoskeletal symptoms.
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Affiliation(s)
- Sang-Rim Kim
- Department of Orthopaedic Surgery, Jeju National University School of Medicine, Ara 1dong, 102 Jejudaehakno, Jeju-si, Jeju, 690-756, South Korea. .
| | - Dimitris Dimitriou
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114.
| | - Uk Nam
- Department of Orthopaedic Surgery, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, South Korea. . . .
| | - Yong-Geun Park
- Department of Orthopaedic Surgery, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, South Korea. . . .
| | - Sung-Wook Choi
- Department of Orthopaedic Surgery, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, South Korea. . . .
| | - Kyu-Bum Seo
- Department of Orthopaedic Surgery, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, South Korea. . . .
| | - Hee Joong Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Kwang Woo Nam
- Department of Orthopaedic Surgery, Jeju National University School of Medicine, Ara 1dong, 102 Jejudaehakno, Jeju-si, Jeju, 690-756, South Korea. .
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21
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Ni Raghallaigh H, Rintoul-Hoad S, Emsley E, Nawrocki J. 'No bladder visible on ultrasound scan--has the patient had a cystectomy?' A case of emphysematous cystitis. BMJ Case Rep 2014; 2014:bcr-2014-207871. [PMID: 25368131 DOI: 10.1136/bcr-2014-207871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Holly Ni Raghallaigh
- Department of Urology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Sophie Rintoul-Hoad
- Department of Urology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Elizabeth Emsley
- Department of Urology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Janek Nawrocki
- Department of Urology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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22
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Wang PZT, Martin PR, Luke PPW. Emphysematous cystitis and necrotizing fasciitis. Can Urol Assoc J 2014; 8:E498-9. [PMID: 25132897 DOI: 10.5489/cuaj.1865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Emphysematous cystitis is an uncommon and often severe infectious condition of the bladder that usually affects women and diabetics. We report a case of a 62-year-old male patient who presented with concomitant emphysematous cystitis and necrotizing fasciitis of the right leg. The patient was initially managed with emergent disarticulation of the right leg. Tissue cultures were positive for Ciprofloxacin-resistant Klebsiella pneumoniae. He was treated with Piperacillin-Tazobactam; however, due to the failure of conservative management of the condition, the patient underwent a cystoprostatectomy with ileal conduit. To our knowledge, this is the first report of concomitant emphysematous cystitis and necrotizing fasciitis requiring aggressive surgical intervention for both diseases.
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Affiliation(s)
- Peter Zhan Tao Wang
- Schulich School of Medicine & Dentistry, University of Western Ontario, Division of Urology, Department of Surgery, London, ON
| | - Paul R Martin
- Schulich School of Medicine & Dentistry, University of Western Ontario, Division of Urology, Department of Surgery, London, ON
| | - Patrick P W Luke
- Schulich School of Medicine & Dentistry, University of Western Ontario, Division of Urology, Department of Surgery, London, ON
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23
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Eken A, Alma E. Emphysematous cystitis: The role of CT imaging and appropriate treatment. Can Urol Assoc J 2013; 7:E754-6. [PMID: 24282470 DOI: 10.5489/cuaj.472] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Emphysematous cystitis is a relatively rare disease characterized by the presence of gas in the bladder wall and/or lumen. The primary risk factor is diabetes mellitus. Emphysematous cystitis should be considered in cases of urinary tract infections in diabetic patients with unusual presentations. Imaging studies are necessary to detect emphysematous cystitis. Accurate diagnosis of the disease and appropriate treatment typically results in a favourable prognosis and can improve the outcome. We present a case of emphysematous cystitis diagnosed by a computed tomography scan in a diabetic woman with poor glycemic control.
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Affiliation(s)
- Alper Eken
- Acibadem Adana Hastanesi Urology Department, Adana, Turkey
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Aboumarzouk OM, Hughes O, Narahari K, Coulthard R, Kynaston H, Chlosta P, Somani B. Emphysematous pyelonephritis: Time for a management plan with an evidence-based approach. Arab J Urol 2013; 12:106-15. [PMID: 26019934 PMCID: PMC4434438 DOI: 10.1016/j.aju.2013.09.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/21/2013] [Accepted: 09/22/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is a life-threatening necrotising kidney infection, but there is no consensus on the best management. METHODS We systematically reviewed previous articles published from 1980 to 2013 that included studies reporting on EPN, and applying the Cochrane guidelines, we conducted a meta-analysis of the results. RESULTS In all, 32 studies were included, with results for 628 patients (mean age 56.6 years, range 33.8-79.9). There were 462 women, outnumbering men by 3:1. Diabetes was present in 85% of the cases. Fevers and rigor (74.7%), pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was associated with 54.4% of deaths while obstructive uropathy was associated with 15.1% of deaths. Computed tomography was diagnostic in all the cases. Percutaneous drainage (PCD) and medical management (MM) alone were associated with a significantly lower mortality rate than was emergency nephrectomy (EN), with an odds ratio (95% confidence interval) for PCD vs. EN of 3.13 (1.89-5.16; P < 0.001), for EN vs. MM of 2.84 (1.62-4.99; P = 0.001), and of 0.91 (0.53-1.56; P = 0.73, i.e., no difference) for PCD vs. MM. Open drainage also had a significantly lower mortality rate than EN, with a ratio of 0.12 (0.02-0.91; P < 0.04). CONCLUSION The overall mortality rate was ≈18%; shock was associated with a high mortality rate and therefore should be managed aggressively. PCD and MM were associated with significantly higher survival rates than EN, and therefore EN should only be considered if the patient does not improve despite other treatments.
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Affiliation(s)
| | - Owen Hughes
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Krishna Narahari
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Richard Coulthard
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Howard Kynaston
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Cracow, Poland
| | - Bhaskar Somani
- Department of Urology, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
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25
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Bagherirad M, Al-Khayyat H. Emphysematous cystitis due to Klebsiella pneumoniae. Med J Aust 2013; 198:506. [PMID: 23682898 DOI: 10.5694/mja12.11387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Mohammad Bagherirad
- Department of Infectious Diseases, Geelong Hospital, Geelong, VIC, Australia.
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Abstract
An 86-year-old woman with type 2 diabetes was admitted with increasing lethargy and hyperglycaemia. On examination she was noted to have a tender and tympanic bladder. CT revealed a distended bladder with gas locules in the bladder wall. She was diagnosed with hyperglycaemic hyperosmolar non-ketosis precipitated by emphysematous cystitis. After systemic antibiotics and bladder drainage via a urethral catheter, her symptoms readily improved. Radiographic appearances of the bladder were normal one week after instigating treatment. Emphysematous cystitis is characterized by gas within the bladder wall. Although rare it is increasingly more recognized with the advent of modern imaging. The mainstay of treatment is antibiotics and bladder drainage. Rarely surgical debridement and even cystectomy is required.
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Unusual case of emphysematous cystitis seen on FDG PET/CT. Clin Nucl Med 2013; 38:e143-5. [PMID: 23354039 DOI: 10.1097/rlu.0b013e318263927a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Emphysematous cystitis is a rare condition requiring immediate aggressive medical attention. Here, we describe a very unusual case of emphysematous cystitis seen on FDG PET/CT. This finding was discovered in an 84-year-old man undergoing FDG PET/CT to monitor a known diagnosis of IgG4-related nodular sclerosis. Images revealed gas within the bladder wall and an anterior gas-filled bladder diverticulum. The patient subsequently developed sepsis with cultures revealing Escherichia coli. This case highlights the importance of recognizing this finding on varied imaging modalities, as life-threatening complications may arise from this condition.
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28
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Hashimoto T, Namiki K, Tanaka A, Shimodaira K, Gondo T, Tachibana M. Emphysematous cystitis following a transrectal needle guided biopsy of the prostate. BMC Infect Dis 2012; 12:322. [PMID: 23176639 PMCID: PMC3519746 DOI: 10.1186/1471-2334-12-322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 11/12/2012] [Indexed: 11/29/2022] Open
Abstract
Background Emphysematous cystitis (EC) is a comparatively rare urinary tract infection characterized by air within the bladder wall and lumen and is usually associated with immunosuppression or poorly controlled diabetes mellitus. Case presentation We report a case of EC in a 70-year-old man who recently underwent transrectal ultrasound needle-guided prostate biopsy, after which he underwent pylorogastrectomy. He did not have any history of diabetes mellitus or any immunosuppressive disease. The patient developed severe sepsis, requiring intravenous antibiotics and urinary catheterization. Despite therapy, the patient developed disseminated intravascular coagulopathy and acute respiratory distress syndrome. Therefore, he was admitted to the intensive care unit, antibiotic coverage was broadened, and danaparoid sodium and sivelestat sodium hydrate was administered. After 20 days, the patient’s condition improved, and on the 28th day, the patient was discharged to home in a good condition without any sequelae. Conclusion Prompt diagnosis and treatment are warranted to prevent potential morbidity of and mortality in cases of EC.
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Affiliation(s)
- Takeshi Hashimoto
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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29
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Qin Y, Tulsidas H, Jaufeerally F, Tan RKL. Emphysematous Cystitis Complicated by Urinary Bladder Perforation: A Case Report. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Emphysematous cystitis is a rare serious complication of urinary tract infection characterised by gas formation in the wall or lumen of the urinary bladder due to bacterial fermentation. We report a case of an 86-year-old female with emphysematous cystitis complicated by anterior bladder wall perforation. Her urine grew Escherichia coli and imaging showed gas collection inside the urinary bladder and outside the ruptured anterior bladder wall. She was treated with antibiotics and bladder irrigation and responded well without surgery. Early diagnosis and treatment improve the outcome, hence the importance of a high index of suspicion.
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Affiliation(s)
- Yan Qin
- Department of Internal Medicine, Singapore General Hospital
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30
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Soga H, Imanishi O. A case of emphysematous cystitis complicated with miliary tuberculosis. Am J Case Rep 2012; 13:234-7. [PMID: 23569536 PMCID: PMC3616067 DOI: 10.12659/ajcr.883449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 08/29/2012] [Indexed: 11/16/2022] Open
Abstract
Background: Emphysematous cystitis occurs mostly in diabetics with poor glycemic control or in immunocompromised patients. In most cases, diabetes mellitus correlates with the occurrence of emphysematous cystitis. The risk of relapse after tuberculosis cure or treatment completion is high among patients with diabetes mellitus. Case Report: A 64-year-old diabetic man suffering from high fever and lower abdominal pain was admitted to the emergency ward. Due to the results of radiographic examinations, he was diagnosed with an emphysematous cystitis. Although the emphysematous cystitis improved with urinary drainage and antibiotic therapy, the high fever recurred and respiratory symptoms appeared. This patient was diagnosed with a crisis of the pulmonary tuberculosis. He was started on the antituberculosis therapy, and he recovered. Conclusions: This is the first report of a case of emphysematous cystitis that was complicated with pulmonary tuberculosis.
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Affiliation(s)
- Hideo Soga
- Department of Urology, Hyogo Prefectural AWAJI Hospital, Shimokamo, Sumoto, Hyogo, Japan
| | - Osamu Imanishi
- Imanishi Urological Clinic, Iwayakitamachi, Nada-ku, Kobe, Hyogo, Japan
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31
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Hata K, Hatano T, Uno T, Tsuzuki S, Koike Y, Kishimoto K, Kira S, Kiyota H, Egawa S, Miyake R, Otani K. [Emphysematous pyelonephritis and cystitis concurrence; A case report]. KANSENSHOGAKU ZASSHI. THE JOURNAL OF THE JAPANESE ASSOCIATION FOR INFECTIOUS DISEASES 2011; 85:674-677. [PMID: 22250460 DOI: 10.11150/kansenshogakuzasshi.85.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of emphysematous pyelonephritis coexisting with emphysematous cystitis. A 57-year-old woman seen for abdominal pain, diarrhea, and high fever had been referred after computed tomography (CT) elsewhere had shown an air density mass in the left kidney and pelvis. Abdominal CT on admission showed emphysematous change in the left renal parenchyma and intramural bladder. Serum analysis results showed disseminated intravascular coagulation (DIC) and uncontrolled diabetes. Klebsiella pneumoniae was isolated in the blood. She was diagnosed with sepsis based on these findings due to concurrent emphysematous pyelonephritis and cystitis caused by K. pneumoniae. She was treated conservatively with meropenem, intravenous immunoglobulin, and gabexate mesilate and cured. Concurrent emphysematous cystitis and pyelonephritis is rare., with ours only the fourth case reported in Japan.
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Affiliation(s)
- Kenichi Hata
- Department of Urology, Jikei University Affiliated Kashiwa Hospital
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32
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Abstract
A 62-year-old diabetic woman suffering from high fever was admitted to our hospital. She had a lower abdominal phantom tumor and hyperglycemia. The results of urine analysis showed hematuria and bacteriuria. X-ray and computed tomography revealed gas accumulation in the wall of the bladder. Escherichia coli was identified in urine culture. On the basis of the lack of urine output and the identification of residual urine on catheterization, a diagnosis of emphysematous cystitis with diabetic neurogenic bladder was established. The patient recovered after discontinuation of urinary drainage, intensive insulin therapy, and antibiotic therapy.
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Affiliation(s)
- Kazuya Yoshida
- Department of Internal Medicine and Clinical Research, Zentsuji National Hospital, Japan.
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33
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Abstract
Emphysematous cystitis is a rare disorder that is usually associated with immunosuppression, poorly controlled diabetes mellitus, and other risk factors such as previous urinary tract infection and/or recent instrumentation of the urinary tract. The case of an 89-year-old woman with emphysematous cystitis who had no evidence of immunodeficiency or other risk factors except for advanced age is reported. A review of the literature on emphysematous cystitis in immunocompetent, nondiabetic individuals is presented.
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34
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Wang CC, Chen YJ, Tsao YT, Chen WL. Image of trauma. Emphysematous cystitis. THE JOURNAL OF TRAUMA 2009; 67:414. [PMID: 19667901 DOI: 10.1097/ta.0b013e318187ad37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Chung-Ching Wang
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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35
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Emphysematous cystitis: An unusual lower urinary tract infection. AFRICAN JOURNAL OF UROLOGY 2009. [DOI: 10.1007/s12301-009-0007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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36
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Sun JT, Wang HP, Lien WC. Life-threatening urinary tract infection. QJM 2009; 102:223. [PMID: 18784192 DOI: 10.1093/qjmed/hcn115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J-T Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei County, Taiwan
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37
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Abstract
It is postulated that gas-forming organisms ferment glucose within the wall of the urinary bladder leading to air collection; emphysematous cystitis occurs due to the fermentation of glucose by these organisms. Emphysematous cystitis is a rare condition usually seen in patients who are either diabetic or have other immunosuppressive diseases, or have had disruption of the bladder wall due to trauma or surgical instrumentation. We present a case of emphysematous cystitis in a patient with cystic fibrosis without any other underlying immunosuppressive conditions which, to our knowledge, is the first reported case. The patient presented with abdominal pain and was diagnosed with abdominal computed tomography examination. She was managed conservatively with a favorable outcome.
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38
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Galiano Baena J, Caballero Romeu J, Galán Llopis J, Leivar Tamayo A, Lobato Encinas J. [Emphysematous cystitis. Case report and review of literature]. Actas Urol Esp 2009; 32:948-50. [PMID: 19044308 DOI: 10.1016/s0210-4806(08)73967-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present the case of a patient with diagnostic of cystitis enphisematous. We carry out the bibliographical revision of other published cases of this pathology. The cystitis enphisematous is an infectious square of strange presentation and more frequent in patient diabetic women, characterized by the presence of gas in the bladder cavity and infiltration of the walls bladder, due to the infection for germs producing of CO2, mainly gram (-). The peculiarity of our case is due to that the patient didn't suffer diabetes, being much more frequent that this alteration happens in the patients that yes they are it.
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39
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Young YR, Sheu BF, Lee CC, Chang SS, Li PL, Wu YS. Images in Emergency Medicine. Ann Emerg Med 2008; 51:230, 261. [DOI: 10.1016/j.annemergmed.2007.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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41
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Juan YS, Huang CH, Chang K, Wang CJ, Chuang SM, Shen JT, Wu WJ. Emphysematous prostatic abscess due to candidiasis: a case report. Kaohsiung J Med Sci 2008; 24:99-102. [PMID: 18281227 DOI: 10.1016/s1607-551x(08)70104-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Prostatic abscess is an uncommon condition and clinical diagnosis is difficult. The classical symptoms and signs of prostatic abscess are variable and nonspecific. Here, we report a rare case of emphysematous prostatic abscess due to candidiasis in a 68-year-old man with diabetes and liver cirrhosis. The diagnosis was confirmed by pelvic computed tomography (CT) and successfully treated by antibiotics and CT-guided percutaneous abscess drainage. This case highlights the importance of early and accurate diagnosis of emphysematous prostatic abscess followed by appropriate treatment.
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Affiliation(s)
- Yung-Shun Juan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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42
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Affiliation(s)
- Nisar Ahmed
- Department of Radiology, Medicine and Pathology, Armed Forces Hospital, Sharourah, Saudi Arabia.
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43
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Casey R, Stunell H, Torreggiani WC, Grainger R. Emphysematous cystitis. Br J Hosp Med (Lond) 2007; 68:498-9. [PMID: 17953309 DOI: 10.12968/hmed.2007.68.9.27175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 70-year-old poorly-controlled type 2 diabetic male presented with a 48-hour history of dysuria, frequency and frank haematuria. He described a 6-week history of worsening bladder outflow obstructive symptoms with nocturia and hesitancy. On examination he had a temperature of 37.5°C and tenderness in the left iliac fossa. Digital rectal examination revealed a tender, smoothly enlarged prostate gland. Blood glucose measurement was significantly elevated at 17 mmol/litre and serum white cell count was elevated at 19×109/litre, demonstrating a marked neutrophilia. A plain film of the abdomen demonstrated the presence of a well-defined area of lucency in the region of the bladder suggestive of air within the bladder wall. A large lucent area was also noted in the left lower quadrant suggestive of a large bladder diverticulum distended with air (Figure 1). Based on these findings, a diagnosis of emphysematous cystitis was considered likely and the patient was commenced on broad-spectrum intravenous antibiotics, intravenous fluids and subcutaneous insulin sliding scale. Subsequent computed tomography of his abdomen and pelvis with intravenous and oral contrast confirmed the presence of emphysematous cystitis with a markedly abnormal, thick-walled bladder as well as air within the bladder wall (Figure 2). The large lucency seen in the left lower quadrant on plain film was shown on computed tomography to represent a 9.7 cm bladder diverticulum, also containing air within its wall (Figure 3). There was no evidence of a colovesical fistula. Urine culture demonstrated a significant growth of Escherichia coli. His clinical course was uneventful and he was discharged home well 7 days later on oral antibiotics for a total of 14 days. He is due for further investigation of his lower urinary tract symptoms with cystoscopy.
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Affiliation(s)
- Rowan Casey
- Department of Urology, The National Children's Hospital, Tallaght, Dublin 24, Ireland
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44
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Yokoo T, Awai T, Yamazaki H, Fukuda Y, Hayashi F, Hosoya T. Emphysematous cystitis complication in a patient undergoing hemodialysis. Clin Exp Nephrol 2007; 11:247-250. [PMID: 17891356 DOI: 10.1007/s10157-007-0478-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Accepted: 04/16/2007] [Indexed: 11/27/2022]
Abstract
Emphysematous cystitis is a rare condition characterized by air formation in and around the bladder wall by gas-forming organisms. Although diabetes mellitus and chronic urinary infection, which are frequently encountered in patients with endstage renal disease (ESRD), are predisposing factors for this entity, emphysematous cystitis is actually not common in ESRD patients. Here we provide the first report of a hemodialysis patient who developed typical emphysematous cystitis. Unlike other cases, the emphysematous cystitis recurred after discontinuation of urinary drainage and antibiotic therapy. The possible reason that this case is of a less common type that is more refractory than the other cases, and the method by which patients with ESRD are commonly treated, are discussed. Not anuric but rather oliguric diabetic patients, even after long-term hemodialysis, are the patients at risk for emphysematous cystitis.
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Affiliation(s)
- Takashi Yokoo
- Department of Internal Medicine, Tokyu Hospital, Tokyo, Japan.
- Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Toshinari Awai
- Department of Internal Medicine, Tokyu Hospital, Tokyo, Japan
| | - Haruki Yamazaki
- Department of Urology, Tokyu Hospital, Tokyo, Japan
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Fumihiro Hayashi
- Department of Internal Medicine, Tokyu Hospital, Tokyo, Japan
- Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tatsuo Hosoya
- Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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45
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Thomas AA, Lane BR, Thomas AZ, Remer EM, Campbell SC, Shoskes DA. Emphysematous cystitis: a review of 135 cases. BJU Int 2007; 100:17-20. [PMID: 17506870 DOI: 10.1111/j.1464-410x.2007.06930.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review recently published data on emphysematous cystitis (EC), a potentially life-threatening condition characterized by air within the bladder wall, and that most typically affects middle-aged diabetic women. METHODS All articles published in English between 1956 and 2006 were identified using a Medline search for keywords "emphysematous cystitis", and "cystitis emphysematosa." Epidemiological, clinical, diagnostic, pathological and therapeutic data were evaluated, including risk factors such as the presence of diabetes mellitus or other comorbid emphysematous infections of the urinary tract. RESULTS In all, 102 published papers, including 135 cases of EC, were reviewed; the median patient age was 66 years, 64% were women and 67% had diabetes mellitus. Most cases were diagnosed using plain films of the abdomen (84%), although more recently, computed tomography was the primary imaging method. Escherichia coli was the most commonly isolated organism. Most patients were treated with medical management alone (90%), while 10% of infections were treated with a combination of medicine and surgery. The overall death rate was 7%. CONCLUSIONS EC is the most common and typically the least severe gas-forming infection of the urinary tract. Prompt diagnosis and treatment is warranted to prevent the potential morbidity and mortality of this infectious condition.
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Affiliation(s)
- Anil A Thomas
- Glickman Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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46
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Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: illustrative case report and review of the literature. Medicine (Baltimore) 2007; 86:47-53. [PMID: 17220755 DOI: 10.1097/md.0b013e3180307c3a] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Emphysematous cystitis is a rare disease characterized by primary infection of the urinary bladder with gas-producing pathogens. There is a paucity of information on this entity in the English-language literature covering the last 45 years, and the clinical picture is poorly outlined. We carried out a comprehensive, retrospective review of the English-language literature from 1986 to 2006, searching for reports describing cases of emphysematous cystitis. The demographic, clinical, laboratory, imaging, and outcome characteristics of every eligible patient were excerpted. In the present report, we describe a typical case of emphysematous cystitis, followed by an analysis of the literature. Of the 53 eligible cases, most were elderly women with diabetes mellitus (62.2%). Classic symptoms of urinary tract infection were present in only 53.3% of cases. Abdominal tenderness and hematuria were noted in 65.6% and 82.3% of cases, respectively. Plain abdominal X-ray was highly sensitive (97.4%), while abdominal computerized tomography was the most sensitive and specific diagnostic tool. A complicated course attributable to emphysematous cystitis was described in 18.8% of cases. The exact mechanism contributing to the formation of gas in such cases is unknown. Various theories have been suggested, including fermentation of glucose in urine, with emphasis on disequilibrium between gas formation and clearance. Emphysematous cystitis has a highly variable presentation and course, with a considerable potential for complications. Further diagnostic imaging is highly recommended in diabetic patients with urinary tract infection who present with abdominal pain and hematuria. Knowledge of this rare entity may lead to early diagnosis and appropriate management.
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Affiliation(s)
- Moti Grupper
- From Infectious Diseases and Urology, Bnai Zion Medical Center and the Rappaport Faculty of Medicine, Technion, Haifa, Israel
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47
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Abstract
We present a rare case of cystitis emphysematosa in an 85-year-old female patient in whom the typical risk factors were present: diabetes of long standing, neurogenic bladder and urinary infection with E.coli. Thanks to early diagnosis by cystoscopy and abdominal CT, after antibiotic treatment, appropriate insulin therapy and continuous bladder drainage the course was uneventful. The patient was fit to leave hospital after 14 days.
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Affiliation(s)
- V Geyer
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Baldingerstrasse, 35033, Marburg, Deutschland.
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48
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Sadick M, Böhm C, Gehrlein M, Düber C. Leitsymptom Akutes Abdomen. Radiologe 2006; 46:698-702. [PMID: 15818487 DOI: 10.1007/s00117-005-1194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Sadick
- Institut für Klinische Radiologie, Universitätsklinikum Mannheim, Fakultät für Klinische Medizin der Universität Heidelberg
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49
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Su YC, Chen CC. Emphysematous cystitis complicating Klebsiella pneumoniae liver abscess. Am J Emerg Med 2006; 24:256-7. [PMID: 16490667 DOI: 10.1016/j.ajem.2005.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 09/14/2005] [Indexed: 10/25/2022] Open
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50
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Petite A, Busoni V, Heinen MP, Billen F, Snaps F. Radiographic and ultrasonographic findings of emphysematous cystitis in four nondiabetic female dogs. Vet Radiol Ultrasound 2006; 47:90-3. [PMID: 16429992 DOI: 10.1111/j.1740-8261.2005.00112.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The urinary bladder of four dogs with emphysematous cystitis was assessed radiographically. Ultrasonography was also performed using a 7.5-MHz microconvex probe in dorsal recumbency and in a standing position. Ultrasonographically there were bright echoes and reverberations typical of gas in all dogs. This was entrapped in the bladder wall as it appeared in the same location in recumbent and standing positions. Bladder size was reduced and bladder content was echogenic in all dogs. In only one out of the four dogs was a gas stripe seen in the bladder on radiographs. Proteus mirabilis was isolated from the urine of all patients. Diabetes was ruled out on the basis of urine and blood analysis. A small amount of gas can be difficult to detect on radiographs. Ultrasonography appears to be a more sensitive technique for detection of gas within the bladder at an early stage of emphysematous cystitis. Prevalence of emphysematous cystitis may be underestimated if only radiographs are made.
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Affiliation(s)
- Audrey Petite
- Department of Diagnostic Imaging, Faculté de Médecine Vétérinaire de Liège, 20, Boulevard de Colonster, Sart-Tilman, 4000 Liége, Belgium.
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