PMC10378586_01
Radiographic imaging before (A, B) and after (C, D) treatment of case 1. (A) After retrograde urography (RGU), ventrodorsal radiography reveals gas within the bladder wall (allow head) and subcutaneous emphysema: ischiorectal fossa (empty arrow). (B) After RGU, there are multiple gases consistent with pneumoperitoneum: retroperitoneum (white arrow). (C, D) Show overall resolution after undergoing antibiotic treatment for 4 weeks. L, left.
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F1
Free gas in the pneumoretroperitoneum and bilateral gluteal area was suspected on abdominal radiography (MDXP-40, MEDIEN, Korea) (Figures 1A, C). After complete EC resolution, the patient discontinued antibiotic treatment (Figures 1B, D).
Transverse (A, C) and sagittal (B, D) CT images (soft tissue window) of case 1. Each presents gases in (A, B) urinary bladder base level, (C) retroperitoneum level, and (D) ischiorectal fossa. Multiple gases are found around the bladder wall and within the bladder (arrowhead). The largest bubble within the bladder wall is 3 mm. Various sizes of gas bubbles are presented in the retroperitoneum (white arrow). In bilateral ischiorectal fossa, each has ~1.5 cm gas (empty arrow).
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F2
CT scanning for more precise evaluation was recommended. CT (Alexion, Toshiba Medical Systems, Japan) scanning revealed multiple pockets of gas in the bladder wall, pneumoperitoneum, around the bladder, the posterior abdominal cavity, and the subcutaneous tissues around the ischiorectal fossa (Figure 2).
PMC10378586_02
Radiographic imaging before (A, B) and after (C, D) treatment of case 2. (A, B) Ventrodorsal and left lateral radiography reveal gas within the bladder wall (allow head). In spite of the patient being diagnosed with EPN through CT, radiography shows both kidneys to be normal. (C, D) Showing overall resolution after undergoing antibiotic treatment for 18 days. L, left.
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F3
Abdominal radiography revealed a moderately expanded bladder and a gas opacity along the bladder wall (Figures 3A, C). Three days later, abdominal radiography showed complete gas resolution (Figures 3B, D), and abdominal ultrasound confirmed remission.
Sagittal (A), dorsal (C), transverse (B, D) CT images (soft tissue window) of case 2. (A, C) Multiple gases are found around the bladder wall and within the bladder (arrowhead). Various sizes of gas bubbles are present in the pelvic cavity posterior to the bladder (empty arrow). (B, D) The accumulation of gases within the parenchyma of both kidneys is found, presenting EPN (white arrow).
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F4
On CT, a large amount of gas was detected around the bladder and some areas of the bladder wall (Figure 4), causing a loss of continuity in the bladder wall.