You have air in WHAT?

Any condition preceded by the term "emphysematous" is generally a bad thing to have. Whilst considered relatively rare, these are important conditions to diagnose and can be detected very well with conventional imaging techniques. They classically all occur more commonly in diabetic patients and are more typically related to infection than ischaemia.

Here is a collection of cases where air in the wall of an organ is evident on imaging.

Emphysematous Cholecystitis

This 52yo diabetic woman presented with non-specific abdominal pain. No previous relevant surgical history or old imaging was available. Following cholecystectomy she had multiple episodes of cholangitis following this acute presentation.

There is a rim of gas outlining the gallbladder in the right upper quadrant; this was effectively an abscess completely filling the gallbladder, with gas penetrating into the necrotic gallbladder wall

Emphysematous Cystitis

This 39yo female patient presented with right-sided abdominal pain, guarding and generalised sepsis. She subsequently went into renal failure and required cystectomy and ileal conduit formation.

The structure in the anterior pelvis containing gas in the wall and a large gas-fluid level is the bladder

Emphysematous Gastritis

This 91yo male patient presented with AF, melaena and haemodynamic instability. Things went downhill quite quickly from here.

3 arrows on this coronal CT highlight gas within the wall of the stomach, small veins leading away from the stomach, and intrahepatic portal veins

Emphysematous Pyelonephritis

This 48yo diabetic patient presented with hyperglycaemia and abdominal pain. She eventually recovered without surgery but with significant scarring to the left kidney.

2 arrows on this coronal CT demonstrate the location of gas within the renal capsule superiorly and in the proximal ureter