Appropriate Use of CT in the Diagnosis of Bladder Rupture

Abstract

42-year-old man sustained a pelvic crush injury t work. On physical examination, he had an untable pelvis, normal digital rectal examination, and o blood at the urethral meatus. Placement of a rethral catheter returned gross blood. Multiple elvic fractures were seen on CT. Injury to the uriary bladder was not seen on cystographic phase T images with the urethral catheter clamped (A). formal CT cystogram revealed an extraperitoneal ladder rupture (B, arrow). The CT cuts are idenical, demonstrating the importance of the formal ystogram. The bladder injury was managed with rethral catheter decompression. Two weeks after is injury, repeat cystography found no extravasaion and the catheter was removed. Bladder injury occurs in approximately 10% of atients with pelvic fractures from blunt trauma. ross hematuria in the presence of pelvic fractures s an absolute indication for cystography. Alhough the cystographic phase of a CT scan may emonstrate bladder injury, this is not a sufficient iagnostic test. Because CT scanning has become outine in the evaluation of the hemodynamically table patient with an unstable pelvis, a retrograde T cystogram should be performed if the integrity f the bladder is in question. This is done by filling he bladder with 350 mL of 4% contrast through he urethral catheter (which is subsequently lamped). When used properly, this technique has ensitivity and specificity of 95% and 100%, espectively.