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Trauma: Bladder Imaging Pearls - Learning Modules | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Trauma ❯ Bladder
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  • “ Multidetector computed tomography (MDCT) cystography is rapidly becoming the most recommended study for evaluation of the bladder for suspected trauma.”
    Bladder trauma: multidetector computed tomography cystography
    Ishak C, Kanth N
    Emerg Radiol (2011)18:321-327
  • Bladder Trauma: Facts
    Trauma mechanisms
    - Blunt trauma (60-85%)
    - Penetrating trauma (15-40%)
    - Iatrogenic trauma (5%)
  • Bladder Trauma: Facts
    - GU trauma occurs in 5-10% of all patients with trauma
    - Bladder injury occurs in 1.6% of blunt trauma cases
    - Bladder rupture occurs in 2-11% of patients with pelvic trauma
    - However, 60-90% of patients with bladder rupture have a pelvic fracture
  • Bladder Trauma: Facts
    - 70-80% of cases are extraperitoneal rupture
    - 15-20% of cases are intraperitoneal rupture
    - 5-10% of cases are combined bladder rupture
    - intraperitoneal rupture has higher morbidity and mortality
  • Bladder Trauma: Facts
    - Usually not isolated injuries but associated with other injuries
    - Mortality reported in up to 44% of patients but obviously relates to other injuries as well
    - CT cystography is needed and has an accuracy approaching 100% for bladder injury
    - 80% of injuries are extraperitoneal and most patients do well as the injury is often self limiting with conservative management
    - 20% of injuries are intraperitoneal and require surgical repair to prevent urine peritonitis
  • Bladder Trauma: Facts
    - 10% of GU system injuries are to the bladder
    - Bladder injures occur in 1.6% of blunt abdominal trauma cases
    - Bladder rupture occurs in 2-11% of patients with pelvic fractures
    - 60-90% of patients with bladder rupture have a pelvic fracture
  • Bladder Trauma: Etiology
    - Blunt trauma (60-85%)
    - Penetrating trauma (15-40%)
    - Iatrogenic trauma (5%)
  • Bladder Trauma: 5 Categories
    - Contusion
    - Intraperitoneal (15-20%)
    - Interstitial or bladder wall hematoma
    - Extraperitoneal (70-80%)
    - Combined (5-10%)
    ---Lower Urinary Tract Trauma
    ---Sandler CM et al
    ---World J Urol 16:69-75
  • Intraperitoneal Bladder Rupture: Facts
    - 15-20% of cases of rupture
    - Delayed diagnosis results in increased mortality due in part to risk of chemical peritonitis
    - Patients require surgical management
  • “ MDCT cystography should be done when pelvic fluid is present, especially when there are fractures or gross hematuria, to define which of the patients has a bladder rupture and to define the type of bladder rupture.”
    Bladder trauma: multidetector computed tomography cystography
    Ishak C, Kanth N
    Emerg Radiol (2011) 18:321-327
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