CT Cystography in Truma

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CT Cystography in theEvaluation of Major

Bladder Trauma

Jonathan P. Vaccaro, MD Jeffrey M. Brody,MD

Presented by Seyed Amir Ebrahimzadeh

Radiographics September-October 2000 Volume 20 Number 5


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CT cystography

CT cystography

classification scheme for bladder injurybased on:

1. The degree of wall injury

2. Anatomic location

3. Demonstrated characteristic imagingfeatures for each type of injury


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CT cystography

CT cystography with retrograde bladder distention(150-300cc)replacing radiography

Diagnostic accuracy approaching 100%

CT scan with intravenous administrated contrast is not feasiblebecause of increased scan time to 30min for delay scans

50 mL of Hypaque 60 [Nycomed, Princeton,NJ] and 450 mL ofnormal saline solution

Postdrainage images through the decompressed bladder are

not required


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CT cystography

CT cystography is routinely considered in

1. Known pelvic fractures2. Gross hematuria

3. Severe pelvic trauma with no known pelvic

fractures


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Classification


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Surgery or conservativemanagement?

Type 2 and 5 need surgery

Type 1 and 3 manage conservatively

Type 4 manage conservatively if urineclear of blood,cathater function well andblader neck is not injured.otherwise surgeryis prefered.


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Type 1

Contusion

Findings are normal in CTcystography


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Type 2

10%20% of major bladder injuries

Direct blow to the already distendedbladder

Intraperitoneal contrast material

1. Around bowel loops,

2. Between mesenteric folds,3. In the paracolic gutters.


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Type 2


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Type 3

An intramural or partial-thicknesslaceration with intact serosa

intramural hemorrhage andsubmucosal extravasation of contrastmaterial without transmural extension.


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Type 3


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Type 4

Usually caused by penetrating trauma

In blunt trauma, the presumed

mechanism is direct laceration of thebladder by bone fragments from a pelvicfracture

a.Simple:Extravasation is confined tothe perivesical space


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Type 4a


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Type 4b


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Type 4b


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Type 5

Combined intra-andextraperitoneal rupture

patterns that are typical for both typesof injury


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Type 5


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Type 5: CombinedRupture?


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NO,its type 4b

Contrast material is seen in theproperitoneal space (extraperitonealsubserous tissue) of the right lower

quadrant.

This should not be confused with

intraperitoneal contrast material.


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Type 4b


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Thank you for yourattentionAny question?


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CT Cystography in Truma

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