PMC10302517_01
(a) Pelvis magnetic resonance image showing invasion of the neoplasm into the bladder (*), tumoral fistula (**), and presence of gas bubbles in the bladder (full arrow). (b) Pelvis magnetic resonance imaging showing an enlarged vesicotumoral fistula (***) and disappearance of gas in the bladder. (c) Computed tomography with coronal plane reconstruction showing the presence of air in the left renal pelvis (single arrow) already with percutaneous nephrostomy, confirming emphysematous pyelonephritis.
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An imaging study on day 107 after admission confirmed an extensive fistulous tract, and the bladder largely infiltrated by the tumor lesion with some gas formation (Figure 1(a)). Post-treatment imaging showed no evidence of gas in the bladder (Figure 1(b)). Nonetheless, it showed gaseous foci interspersed in the calices and left renal pelvis, no gas in the bladder (Figure 1(c)), an increase in the vesicotumor fistula, and cancer progression with lung metastasis.