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CT Cystography with Multiplanar Reformation for Suspected Bladder Rupture: Experience in 234 Cases

David P. N. Chan1, Hani H. Abujudeh2, George L. Cushing, Jr.2 and Robert A. Novelline2

1 Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin, Hong Kong.
2 Department of Radiology, Massachusetts General Hospital, Boston, MA 02114.


Figure 1
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  		Fig. 1A —19-year-old man with extraperitoneal bladder rupture after motor vehicle collision. CT cystography images (A, axial; B, coronal; C, sagittal) show site of bladder rupture at right lateral wall (arrows) with contrast extravasation into extraperitoneal space (arrowheads).

 

Figure 2
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  		Fig. 1B —19-year-old man with extraperitoneal bladder rupture after motor vehicle collision. CT cystography images (A, axial; B, coronal; C, sagittal) show site of bladder rupture at right lateral wall (arrows) with contrast extravasation into extraperitoneal space (arrowheads).

 

Figure 3
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  		Fig. 1C —19-year-old man with extraperitoneal bladder rupture after motor vehicle collision. CT cystography images (A, axial; B, coronal; C, sagittal) show site of bladder rupture at right lateral wall (arrows) with contrast extravasation into extraperitoneal space (arrowheads).

 

Figure 4
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  		Fig. 2A —34-year-old woman with intraperitoneal bladder rupture after motor vehicle collision. CT cystography images (A, axial; B, coronal; C, sagittal) show site of bladder rupture at dome (arrows) with contrast extravasation into peritoneal space (arrowheads). Note enlarged uterus with fibroids (F).

 

Figure 5
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  		Fig. 2B —34-year-old woman with intraperitoneal bladder rupture after motor vehicle collision. CT cystography images (A, axial; B, coronal; C, sagittal) show site of bladder rupture at dome (arrows) with contrast extravasation into peritoneal space (arrowheads). Note enlarged uterus with fibroids (F).

 

Figure 6
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  		Fig. 2C —34-year-old woman with intraperitoneal bladder rupture after motor vehicle collision. CT cystography images (A, axial; B, coronal; C, sagittal) show site of bladder rupture at dome (arrows) with contrast extravasation into peritoneal space (arrowheads). Note enlarged uterus with fibroids (F).

 

Figure 7
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  		Fig. 3A —29-year-old man with intraperitoneal bladder rupture who was struck by motor vehicle. Axial CT cystography image shows contrast extravasation into peritoneal space (arrowheads), but exact site of rupture cannot be determined.

 

Figure 8
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  		Fig. 3B —29-year-old man with intraperitoneal bladder rupture who was struck by motor vehicle. and C, Coronal (B) and sagittal (C) CT cystography images show site of bladder rupture at dome (arrows) with contrast extravasation into peritoneal space (arrowheads).

 

Figure 9
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  		Fig. 3C —29-year-old man with intraperitoneal bladder rupture who was struck by motor vehicle. Coronal (B) and sagittal (C) CT cystography images show site of bladder rupture at dome (arrows) with contrast extravasation into peritoneal space (arrowheads).

 

Figure 10
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  		Fig. 3D —29-year-old man with intraperitoneal bladder rupture who was struck by motor vehicle. Retrospective review of axial CT cystography image at corresponding level shows possible location of rupture at bladder dome (arrow) with contrast extravasation into peritoneal space (arrowhead), but rupture is not well seen because scanning plane is parallel to bladder dome.

 

Figure 11
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  		Fig. 4A —66-year-old woman who was struck by motor vehicle. Axial CT cystography image shows site of bladder rupture at anterior wall (arrow) with contrast extravasation into extraperitoneal space (black arrowhead). Extravasated contrast agent posterior to bladder wall (white arrowhead) was thought to be intraperitoneal rupture component. Initial interpretation was combined intraperitoneal and extraperitoneal rupture.

 

Figure 12
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  		Fig. 4B —66-year-old woman who was struck by motor vehicle. and C, Coronal (B) and sagittal (C) CT cystography images show site of intraperitoneal bladder rupture (arrow) and extraperitoneal rupture (black arrowheads). Note extravasated contrast agent was underneath peritoneal reflection as shown in C (white arrowheads), and there was no extravasated urine surrounding loops of bowel.

 

Figure 13
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  		Fig. 4C —66-year-old woman who was struck by motor vehicle. Coronal (B) and sagittal (C) CT cystography images show site of intraperitoneal bladder rupture (arrow) and extraperitoneal rupture (black arrowheads). Note extravasated contrast agent was underneath peritoneal reflection as shown in C (white arrowheads), and there was no extravasated urine surrounding loops of bowel.

 

Figure 14
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  		Fig. 5A —29-year-old woman after motor vehicle collision. Axial CT cystography image superior to bladder level shows contrast extravasation into peritoneal space (arrowheads) outlined by adjacent bowel loops.

 

Figure 15
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  		Fig. 5B —29-year-old woman after motor vehicle collision. Axial CT cystography image at bladder level shows a small amount of fluid lateral to bladder but no contrast extravasation is seen (arrows). CT cystogram was interpreted as intraperitoneal rupture with probability of extraperitoneal rupture. Injury was confirmed to be combined intraperitoneal and extraperitoneal rupture by surgical bladder exploration.

 

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