1. Bladder: stress cystograms for assessment of suspected bladder injury following blunt trauma to pelvis. (A) Stress cystogram in patient with gross hematuria and pelvic fracture, demonstrating adequate bladder filling and typical pattern of extraperitoneal extravasation—flame-shaped contrast density lateral to right lower bladder segment. Injury managed successfully with 10 days of catheter drainage. (B) Washout phase following stress cystogram. Extraperitoneal extravasation pattern noted in right hemipelvis. Washout films may reveal extravasated contrast anterior or posterior to the contrast-filled bladder, which can be missed on films obtained when the bladder is filled with contrast. (C) Lateral compression of bladder from pelvic hematoma, along with extraperitoneal extravasation pattern in right pelvis, on an incomplete washout film. (D) Intraperitoneal bladder rupture. Note extravasated contrast outlining colic gutters, surrounding loops of small bowel, and occupying cul-de-sac in pelvis, indicative of intraperitoneal contrast. (E) Intraperitoneal bladder rupture. Again, note contrast in pelvis and outlining of right colon and small bowel in pelvis. Cystograms following penetrating pelvic trauma with hematuria. (F) Gunshot wound to pelvis in patient with microscopic hematuria. Bladder is intact, but is displaced to right due to large, left-sided pelvic hematoma. Obturator vessel injury noted; vessels ligated following evacuation of hematoma at laparotomy and pelvic exploration. (G) Gunshot wound to bladder with intravesical clot creating filling defect in bladder. Bladder incompletely filled; extravasation noted on subsequent film, following optimal filling of bladder.
Source: Chapter 36. Genitourinary Trauma, Trauma, 7e
Citation: Mattox KL, Moore EE, Feliciano DV. Trauma, 7e; 2013 Available at: Accessed: October 21, 2017
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