A 74-year-old man presented to the Emergency Department after a fall from a ladder. Plain radiographic screening of the lumbar spine revealed an unanticipated curvilinear, oval-shaped air configuration in the pelvis. Computed tomography of the lumbar spine showed air within the bladder wall and lumen. Urine cultures were positive for Escherichia coli. The patient was discharged after bladder drainage and empiric antibiotic treatment.