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CT Cystography

Radiographic and Clinical Predictors of Bladder Rupture

Desiree E. Morgan1, Lakshmi K. Nallamala1, Philip J. Kenney1, Matthew S. Mayo2 and Loring W. Rue3

1 Department of Radiology, University of Alabama, 619 S. 19th St. Birmingham, AL 35233.
2 Department of Biostatistics, Kansas Cancer Institute, 3901 Rainbow Blvd., Kansas City, KS 66160-7312.
3 Department of Surgery, The Trauma Center of the University of Alabama, Birmingham, AL 35233.



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  		Fig. 1. — 59-year-old man with extraperitoneal bladder rupture and fractured pelvis.

A, Standard IV contrast—enhanced CT scan through base of bladder shows displaced iliac fracture (black arrow) and reveals small amount of opacified urine in bladder base and fluid within extraperitoneal deep pelvic space (arrow).

 


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  		Fig. 1. — 59-year-old man with extraperitoneal bladder rupture and fractured pelvis.

B, CT cystogram at level similar to A shows iliac fracture and full distention of bladder. Note extravasation of retrogradely administered contrast medium into extraperitoneal space (white arrow).

 


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  		Fig. 2. — 49-year-old man with isolated acetabular fracture and normal findings on CT cystogram.

A, Contrast-enhanced CT scan through bladder base reveals posterior column right acetabular fracture (arrow) and no pelvic fluid.

 


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  		Fig. 2. — 49-year-old man with isolated acetabular fracture and normal findings on CT cystogram.

B, CT cystogram at level of acetabular roof shows full bladder distention with no extravasation of contrast medium.

 


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  		Fig. 3. —38-year-old man with intraperitoneal bladder rupture.

A, Contrast-enhanced CT scan above bladder dome reveals free intraperitoneal fluid (arrow). No extravasation of contrast medium was seen on more inferior images (not shown) during standard contrast-enhanced CT.

 


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  		Fig. 3. —38-year-old man with intraperitoneal bladder rupture.

B, CT cystogram shows extravasated contrast medium (arrows) in intraperitoneal location surrounding bladder dome.

 


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  		Fig. 4. —49-year-old man with microhematuria and normal findings on CT cystogram.

A, Contrast-enhanced CT scan through bladder base reveals partial antegrade filling of bladder with excreted contrast medium. Neither pelvic fracture nor pelvic fluid was noted.

 


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  		Fig. 4. —49-year-old man with microhematuria and normal findings on CT cystogram.

B, CT cystogram at slightly higher level than A shows smooth bladder contour without extravasation.

 

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