Conventional radiography of emphysematous cystitis characteristically shows curvilinear or mottled areas of increased radiolucency in the region of the urinary bladder, separate from more posterior rectal gas. Intraluminal gas will be seen as an air-fluid level that changes with patient position, and, when adjacent to the nondependent mucosal surface, may have a cobblestone or "beaded necklace" appearance. This finding reflects the irregular thickening produced by submucosal blebs as seen at direct cystoscopy . US will commonly demonstrate diffuse bladder wall thickening and increased echogenicity. Focal regions of high-amplitude echoes with posterior dirty acoustic shadowing into the lumen may be seen in extensive cases . CT is a highly sensitive ex-amination that allows early detection of intraluminal orintramural gas . It is also useful in evaluating other causes of intraluminal gas such as enteric fistula formation from adjacent bowel carcinoma or inflammatory disease.

Underlying diabetes mellitus is present in over half of reported cases, with women being affected twice as often as men . Other predisposing conditions include chronic urinary tract infections, bladder outlet obstruction, and a neurogenic bladder.