Case Study

06_00134 Ellie M Emphysematous cystitis

A 12-year-old SF Golden retriever was presented for evaluation of chronic intermittent urinary tract infections over a 4 year-period. Different bacteria and sensitivity have been cultured. More recently there was recurring hematuria. On physical examination the vulva was recessed with matted hair. Urinalysis showed proteinuria and bacilli.

Sonographic Differential Diagnosis

Emphysematous cystitis. Chronic cystitis bladder pattern.
Recommend a new culture with anaerobic and aerobic culture, Enrofloxacin, Clindamycin combination would be recommended over the next 6 weeks. Consideration of a 72 hour IV fluid protocol in order to help diurese this patient and eliminate excessive debris may also prove fruitful. A recheck culture is recommended in 4 weeks with a recheck sonogram in 6 weeks prior to stopping antibiotics. Assessment of the vaginal vestibule is recommended for predisposing causes of recurrent urinary tract infection such as urine pooling or recessed vulva.

Image Interpretation

The urinary bladder presented a large amount of debris and thickened wall, primarily ventral wall. This measured 1.02 cm. The bladder presentation is most consistent with chronic cystitis. Air accumulation was noted within the bladder as well. This is consistent with anaerobic infection.

DX

Emphysematous cystitis

Outcome

None

Clinical Differential Diagnosis

Resistant bacterial cystitis, polyploid cystitis, neoplasia, granulomatous cystitis, uroliths
Stump pyometra
Ascending UTI from recessed vulva/vaginal urine pooling