Presentation
Right upper quadrant pain. History of metastatic melanoma.
Patient Data
Antidependent locules of gas within the bladder wall, consistent with emphysematous cystitis.
Innumerable ill-defined hypoattenuating rounded lesions throughout the liver are consistent with metastases in the given clinical scenario. The main portal vein and its right and left branches remain patent. No ascites. The previously seen ill-defined splenic lesion also likely metastasis in this setting.
Large volume of feces within the rectum. Intrauterine device. The gallbladder, adrenals, kidneys, pancreas and small bowel are normal in appearance.
Case Discussion
Emphysematous cystitis is a relatively uncommon variant of urinary tract infection characteristic by gas within the wall of the urinary bladder, secondary to infection by gas-forming bacteria or fungi.
It is most commonly seen in the setting of diabetes mellitus, but other risk factors include immunocompromise, neurogenic bladder, urinary tract outlet obstruction, chronic UTIs and long term indwelling urethral catheters.
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