A 70-year-old woman presented with a 2-day history of progressively worsening oral intake and general weakness. The patient suffered from hypertension and type 2 diabetes mellitus. She was febrile and had rapid respirations. Laboratory evaluations revealed blood urea nitrogen of 67mg/dl, a creatin-ine level of 3.2mg/dl and glucose 510mg/dl. Urinalysis revealed dark, cloudy urine with numerous white and red cells. A pelvic X-ray revealed circumferential air in the bladder wall and a markedly dilated bladder cavity (Figure 1, arrows). The residual urine volume via urethral catheterization was 1500 ml. A computed tomography scan of her pelvis showed a diffusely thickened bladder wall with linear gas trapping along the wall (Figure 2, arrowheads). Urine and blood cultures grew extended-spectrum (3-lactamase-producing Escheri-chia coli. After 6 weeks of antibiotic treatment and urethral catheterization, the gas present in the bladder wall had decreased dramatically, and her renal function is stable.
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