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Delayed Traumatic Bladder Rupture

Martin Laufik, Darren Buono, Giovanna Casola and Claude Sirlin

University of California, San Diego, 200 W Arbor Dr., San Diego, CA 92103-8756.



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  		Fig. 1A. —17-year-old girl after motor vehicle accident. Admission unenhanced pelvic CT reconstructed with bone algorithm shows bone spicule (arrow) contiguous with bladder neck (note Foley catheter in bladder neck). Numerous other pelvic fractures were present (not shown). No evidence of injury to urinary tract was seen on follow-up contrast-enhanced abdominopelvic CT (not shown).

 


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  		Fig. 1B. —17-year-old girl after motor vehicle accident. CT cystogram with 300 mL of 10% nonionic contrast agent (ioversol injection USP 68%, 320 mg I/mL, Optiray 320, Mallinckrodt). Distended bladder is intact; no evidence of extravasation or intraluminal filling defects is seen.

 


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  		Fig. 1C. —17-year-old girl after motor vehicle accident. CT image through level of acetabulum shows small amount of extraperitoneal fluid (arrows) but no focal collection.

 


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  		Fig. 1D. —17-year-old girl after motor vehicle accident. CT cystogram with 150 mL of dilute 10% ioversol performed 8 days after initial presentation shows new extraperitoneal extravasation from bladder neck. Note close proximity of bony spicule (arrow) to area of extravasation.

 


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  		Fig. 1E. —17-year-old girl after motor vehicle accident. CT image through level of bladder reveals new 6-cm intraluminal hematoma (H) within bladder.

 


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  		Fig. 1F. —17-year-old girl after motor vehicle accident. CT image through level of acetabulum shows new 3-cm perivesicular collection (arrows) containing gas and fluid. Gas within collection is presumably related to air introduced into bladder via catheterization. On subsequent CT cystograms (not shown), this collection communicated with bladder neck.

 

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