The n e w e ng l a n d j o u r na l of m e dic i n e

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Air in the Urinary Tract

A 
Chih-Cheng Lu, M.D. 53-year-old woman was admitted to the hospital for evaluation
Tse-Chou Cheng, M.D. of a 1-week history of lower abdominal pain and dysuria. She was afebrile.
Plain abdominal radiography showed air throughout the urinary tract in the
Chi Mei Medical Center ICM AUTHOR Lu RETAKE 1st
Liouying,Taiwan kidneys, ureters, and bladder (arrows).
REG F FIGURE a
The laboratory data showed 2nd elevated levels of
lu@ms6.hinet.net blood glucose (519 mgCASEper deciliter
TITLE [28.8 mmol per liter]), C-reactive
3rd protein (37.1 mg
Revised
per liter), and serum creatinine
EMail (1.6 mg per deciliter
Line [141
4-C µmol per liter]). The white-cell
SIZE
count was 11.9×103 perEnoncubicARTIST:
millimeter.
mst Computed
H/T tomography
H/T confirmed the radio-
FILL Combo 28p
graphic finding of acute emphysematous cystitis. A urine culture grew Escherichia coli,
AUTHOR, PLEASE NOTE:
and the patient had a goodFigure
response toredrawn
has been antibiotic treatment.
and type Patients with diabetes mel-
has been reset.
litus have a predisposition to complicated urinary
Please check tract infections such as emphysema-
carefully.

tous cystitis, which is thought to be caused by fermentation of glucose by bacterial

JOB: 36104 ISSUE: 7-23-09
and fungal pathogens.
Copyright © 2009 Massachusetts Medical Society.

388 n engl j med 361;4  nejm.org  july 23, 2009

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