[Emphysematous cystitis with air bubbles in the vena cava]

Area of Science:

• Urology
• Infectious Diseases
• Radiology

Background:

• Emphysematous urinary tract infections (UTIs), particularly emphysematous cystitis, are severe conditions associated with high mortality.
• The presence of venous gas bubbles in conjunction with emphysematous UTIs is a rare finding, potentially contributing to increased fatality rates due to risks like air embolism.

Observation:

• A 76-year-old diabetic female presented with fever and abdominal pain, found to have gas in the bladder wall and inferior vena cava via CT scan.
• Escherichia coli was identified as the causative agent of the urinary tract infection.

Findings:

• The patient recovered following antibiotic therapy and urinary drainage, with subsequent CT scans showing resolution of gas accumulation.
• This case represents the fourth reported instance of venous gas bubbles associated with emphysematous cystitis, suggesting a potential link between gas translocation and disease severity.

Implications:

• The findings suggest that bacterial bladder wall injury and elevated bladder pressure, possibly from urinary outlet obstruction, may facilitate gas entry into the venous system.
• Early recognition and management of emphysematous UTIs with venous gas are crucial for improving patient outcomes and potentially reducing mortality.