To the Editor:  

In the February case report by Jeremy K. Selley, DO, and colleagues¹ regarding emphysematous cystitis, the authors state that pneumaturia is “the characteristic pathognomonic finding in emphysematous cystitis.” However, I would like to point out that pneumaturia is more commonly associated with a colovesical fistula—in 52% to 77% of cases, often a result of Crohn's disease or diverticulitis²—than with emphysematous cystitis. Thus, a finding of pneumaturia in a patient's medical history would not necessarily be indicative of emphysematous cystitis, as Selley et al¹ imply. 

Furthermore, the statement by Selley et al¹ that emphysematous cystitis has a 20% mortality rate is erroneous, as suggested by the fact that this condition rarely calls for surgical debridement. By contrast, the similarly named but very different entity of emphysematous pyelonephritis, which has a reported mortality rate of 19% to 43%,³ often calls for emergency surgical debridement to save lives.