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Cystitis and Ureteritis Emphysematosa

1957; Radiological Society of North America; Volume: 68; Issue: 6 Linguagem: Inglês

10.1148/68.6.866

1527-1315

Constantine Soteropoulos, Eiji Kawashima, John H. Gilmore,

Urologic and reproductive health conditions

Several articles have appeared recently regarding cystitis emphysematosa, indicating the increasing interest in this entity and showing the value of early diagnosis and treatment. So far as we are aware, however, the complication of ureteritis emphysematosa has not been reported previously. Case Report A 68-year-old white woman with poorly controlled diabetes was admitted to the hospital for gastrointestinal study because of vague abdominal complaints, diarrhea, weakness, and anemia. On the day of the gastrointestinal examination, nausea and vomiting developed and the gallbladder was found to be filled with calculi. The patient improved under conservative management, but two days later experienced sudden lower abdominal pain with urgency and frequency. A tender mass, which proved to be a distended urinary bladder, was palpated in the lower abdomen. The patient was sent to the x-ray department with a clinical diagnosis of “acute abdomen.” Roentgenograms showed the characteristic findings of cystitis emphysematosa, with extension of the changes into the distal thirds of both ureters (Fig. 1). In the decubitus view a large fluid level was seen in the urinary bladder. After evacuation, the radiolucent zone followed the contraction of the wall of the bladder (Figs. 2 and 3). A roentgenogram of the abdomen forty-eight hours later showed no evidence of abnormality. Catheterization yielded bloody urine. Culture of the urine specimen yielded a growth of B. coli and aerogenes. Non-protein nitrogen was 28 mg. per 100 c.c. The blood sugar was 332 mg. per 100 c.c. The white cell count was 12,500; hemoglobin 11.0 gm. The urine output decreased for a period of two days to approximately 400 c.c. daily. The temperature was 100.5° for four days. The patient improved rapidly after receiving antibiotics and fluids intravenously. Cystoscopy, after two and a half weeks, showed an intensely red bladder mucosa with many rugae and an abundance of tenacious clots and mucous material. A second cystoscopic study two weeks following the first revealed a “persistent red, edematous area the size of a dollar, having the appearance of residual inflammatory reaction.” A cholecystectomy was performed, and the patient was discharged a month and a half later in good condition. Discussion The pathogenesis of cystitis emphysematosa has been covered in recent articles and need not be discussed here. Our patient presented a clinical course and roentgenographic findings similar to those previously reported. The cause of the infection was found on urine culture. The response to treatment was remarkable. The marked improvement of the condition in twenty-four hours shows again the value of early diagnosis. The unusual feature of the case is the extension of the changes in the bladder wall into the ureters. Anatomically the mucous membrane of the ureter is continuous with the mucous membrane of the urinary bladder and resembles it.