Spontaneous Bladder Wall Rupture Due to Emphysematous Cystitis

Case History A 74-year-old woman presented with a vague suprapubic pain and progressive deterioration of her general condition. CT examination showed a partially air filled bladder with disruption of the bladder wall on the right posterolateral side. There was no intra-abdominal free air or free fluid. The bladder was slightly thickened (Figure 1). In Lung window, multiple air-filled mucosal bullae of the bladder were demonstrated (Figure 2). The latter is suggestive of an emphysematous cystitis (EC). Patient was treated conservatively with placement of a Foley catheter and with IV antibiotics. One week later, follow-up CT was performed; this showed a spontaneous healing of the bladder wall with only a small residual focus of free air in the Retzius space (Figure 3, arrow).