Type:
Educational Exhibit
Keywords:
Trauma, Education and training, Technical aspects, Cystography / Uretrography, Contrast agent-other, Ultrasound, Fluoroscopy, CT, Urinary Tract / Bladder, Emergency, Abdomen
Authors:
M. Grilli Wagnerová1, M. Holesta1, Z. Valova2, J. Weichet2, H. Malikova1; 1Praha/CZ, 2Prague/CZ
DOI:
10.26044/ecr2019/C-2071
Findings and procedure details
In recent years we have found several iatrogenic perforations of the urinary bladder,
mostly after TURB due to bladder tumor.
One representative case of such IBT is presented in Fig 4.
During last 4 years we have identified 10 urinary bladder ruptures after blunt trauma; 6 extraperitoneal and 4 intraperitoneal ruptures.
We are presenting four cases as a demonstration of various kinds of urinary bladder trauma and its imaging:
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A case of a female pedestrian injured during a car accident.
She suffered a minor head injury and a complex fracture of the pelvic ring.
Initially,
there were no signs of urinary bladder rupture on the CT excretory phase.
Due to a macroscopic hematuria,
fluoroscopic cystography was performed one hour later.
A leakage of contrast agent from the urinary bladder was visible on the right side of the bladder (Fig.5).
The subsequent surgery proved an atypical intraperitoneal urinary bladder rupture.
Negative CT cystography cannot exclude urinary bladder rupture for certain.
Repeated examination is required.
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A case of a car driver who hit the roadside barriers.
She complained of pelvic pain on admission to our center.
No major osseous injury was detected on CT,
but there was free dense peritoneal fluid in pelvis.
A typical rupture of urinary bladder dome was found (Fig.7).
The bladder dome is the weakest part,
thus vulnerable to injury as the bladder is distended with urine and rises into the peritoneal cavity.
Intraperitoneal ruptures are caused by a sudden intravesical pressure increase of distended bladder,
secondary to a blow to the pelvis or lower abdomen.
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A case of a young patient after car crash.
Pelvic and left pertrochanteric fractures were found and a typical extraperitoneal rupture of urinary bladder is visible (Fig.8).
Extraperitoneal ruptures are almost always associated with pelvic fractures.
The injury is usually caused by distortion of the pelvic ring,
with shearing of the anterolateral bladder wall near the bladder base (at its fascial attachments).
Spontaneous urinary bladder rupture is extremely rare.
We have seen it once in a young male patient after surgical repair of exstrophy bladder (Fig 9).