Visual Diagnosis in Emergency Medicine
Emphysematous Cystitis

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Introduction

We present a case of an 87-year-old woman with emphysematous cystitis. This rare but potentially fatal complication of urinary tract infection is difficult to diagnose based on history and physical examination alone. Advanced imaging is usually required, and should be performed whenever this condition is suspected.

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Case Report

An 87-year-old female with a medical history of hypertension and type 2 diabetes presented to the emergency department after a mechanical fall. Her family reported that she had been increasingly fatigued in the several days before presentation and she had been experiencing hematuria as well. She complained of left-sided rib pain and left upper quadrant pain. Physical examination revealed a mildly distressed elderly female with normal vital signs and tenderness to palpation over her left chest

Discussion

Emphysematous cystitis is an uncommon complication of urinary tract infection that is caused when gas-forming organisms, usually Escherichia coli or Klebsiella, ferment glucose into carbon dioxide and fill the bladder lumen and wall with gas (1). Its true incidence in unknown, but it most commonly affects female patients who are elderly, diabetic, or otherwise immunocompromised (2).

Presenting symptoms range from none at all to severe sepsis, but abdominal pain, hematuria, and fever are the most

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