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 #Emphysematous #Cystitis #diagnosis #management
