CTICasesEmphysematous Cystitis and Pyelonephritis with Venous Gas
Imaging findings
A poorly controlled diabetic who was quite ill has an abdominal radiograph showing lucent gas collections at the expected locations of the kidneys. CT shows gas in the right ventricle, portal veins, both kidneys, the inferior vena cava/renal vein, and the bladder wall, consistent with emphysematous cystitis and pyelonephritis with disseminated venous gas.
Key takeaways
Emphysematous urinary tract infection in a poorly controlled diabetic can produce gas in the bladder wall and kidneys with extension into the renal and portal venous systems and even cardiac chambers, a striking and ominous constellation carrying a very poor prognosis. Unusual gas collections seen below the diaphragm on chest imaging warrant careful evaluation.
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