Emphysematous cystitis is a rare condition in which gas-forming organisms produce gas in the bladder wall and lumen. We present a case of emphysematous cystitis with neurogenic bladder. The patient was a 78-year-old man who complained of dysuria and lower abdominal soft mass. Urine culture yielded Klebsiella pneumoniae and Enterococcus faecalis. A plain X-ray film of upright position showed a large air-fluid level. The gas was demonstrated in the bladder wall and lumen on CT scan. These findings were compatible with that of emphysematous cystitis. The symptoms were improved and the intraluminal gas had disappeared on radiography after treatment with antibiotics. We reviewed 20 cases of emphysematous cystitis reported in the Japanese literature and reported clinical characteristics of 21 patients including ours here.