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Imaging of Genitourinary Trauma

¹ Both authors: Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St., Philadelphia, PA 19104.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Traumatic adrenal hematoma. 52-year-old man after motorcycle collision. Unenhanced CT scan reveals high-density right adrenal mass (arrow) suspected to be hematoma.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Traumatic adrenal hematoma. Follow-up contrast-enhanced CT scan obtained approximately 10 weeks later in same patient as in A shows resolution of right adrenal hematoma.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Traumatic adrenal hematoma. 12-year-old boy after motor vehicle collision who has right adrenal hemorrhage. Sagittal sonogram shows right adrenal gland to be enlarged and predominantly hypoechoic, consistent with acute hemorrhage.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Renal contusion and segmental arterial injury in two patients with blunt trauma. 43-year-old woman after fall from height. Enhanced CT scan reveals bilateral ill-defined foci of diminished enhancement, consistent with renal contusions (arrows). Note perinephric hematoma on right (arrowheads).

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Renal contusion and segmental arterial injury in two patients with blunt trauma. 22-year-old man after fall from height. Enhanced CT scan reveals sharply demarcated perfusion defect, presumably due to segmental arterial injury. Note retroperitoneal hematoma in retrocaval region (arrow).

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Deep parenchymal injuries in two patients with renal trauma. 50-year-old woman after motor vehicle collision. Enhanced CT scan in nephrographic phase reveals deep left renal lacerations and perinephric hematoma.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Deep parenchymal injuries in two patients with renal trauma. 28-year-old woman after gunshot wound. Nephrographic phase CT scan reveals linear cleft in medial aspect of right kidney and surrounding hematoma. Densities in hematoma (black arrows) reflect active arterial bleeding. Small locules of gas in right paraspinal muscles (white arrows) are related to track of shotgun wound.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Collecting system injury in 18-year-old man with blunt abdominal trauma shown on delayed excretory phase imaging. Nephrographic phase CT scan shows severely lacerated right kidney and large surrounding fluid collection of hematoma and urinoma.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Collecting system injury in 18-year-old man with blunt abdominal trauma shown on delayed excretory phase imaging. Excretory phase of CT urogram shows extravasation of urine from right kidney (arrows).

View larger version (172K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Collecting system injury in 18-year-old man with blunt abdominal trauma shown on delayed excretory phase imaging. Sagittal multiplanar reformation of same study as in B shows numerous lacerations (arrows) in right kidney as well as extravasated urine (arrowheads).

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —45-year-old woman with perinephric fluid who was involved in motor vehicle collision. CT scan in early excretory phase shows right renal lacerations and perinephric fluid.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —45-year-old woman with perinephric fluid who was involved in motor vehicle collision. Late excretory phase image shows that perinephric fluid is combination of hematoma and extravasated urine.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Traumatic renal arterial and venous injury in two patients. 23-year-old man with vascular pedicle injury after motorcycle collision. Nephrographic phase CT scan shows near total absence of enhancement in left kidney. Left renal artery (arrow) terminates abruptly. There was also left perinephric hematoma as well as hemoperitoneum from associated splenic injury (not shown).

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Traumatic renal arterial and venous injury in two patients. 52-year-old man after blunt trauma during karate practice resulting in traumatic left renal vein thrombosis. Contrast-enhanced CT scan shows large filling defect (white arrows) in left renal vein. Also note relatively delayed enhancement of left kidney, which is still in corticomedullary phase, compared with right kidney, which already shows some contrast excretion into collecting system (black arrow). Left kidney is enlarged, and perinephric fluid and stranding are present.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —42-year-old woman with bleeding from left renal angiomyolipoma after motor vehicle collision. Contrast-enhanced CT scan shows large exophytic mass containing fat (white arrow) and multiple foci of contrast extravasation (black arrows). Note surrounding hematoma and anterior displacement of kidney.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —Right ureteral injury as a complication of hysterectomy in 51-year-old woman. Delayed axial image from CT urography shows jet of contrast material (arrow) extending from injured right ureter. Large amount of urinomatous ascites is present, with some layering of contrast material present dependently in pelvis.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —34-year-old man with extraperitoneal bladder rupture after motor vehicle collision. Extraluminal bladder contrast is not seen when there is passive filling of bladder with excreted IV contrast material but is visualized well when bladder is actively distended on CT cystogram. Delayed axial image from contrast-enhanced CT of pelvis shows excreted contrast material (and Foley catheter balloon) in bladder as well as small amount of surrounding fluid (arrows), but no extraluminal contrast material is detected. Note that bladder appears quite distended.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —34-year-old man with extraperitoneal bladder rupture after motor vehicle collision. Extraluminal bladder contrast is not seen when there is passive filling of bladder with excreted IV contrast material but is visualized well when bladder is actively distended on CT cystogram. CT cystograms show extraperitoneal rupture and large amount of contrast material in prevesical space and extending into superficial soft tissues.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —34-year-old man with extraperitoneal bladder rupture after motor vehicle collision. Extraluminal bladder contrast is not seen when there is passive filling of bladder with excreted IV contrast material but is visualized well when bladder is actively distended on CT cystogram. CT cystograms show extraperitoneal rupture and large amount of contrast material in prevesical space and extending into superficial soft tissues.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9D —34-year-old man with extraperitoneal bladder rupture after motor vehicle collision. Extraluminal bladder contrast is not seen when there is passive filling of bladder with excreted IV contrast material but is visualized well when bladder is actively distended on CT cystogram. CT cystograms show extraperitoneal rupture and large amount of contrast material in prevesical space and extending into superficial soft tissues.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —Intraperitoneal bladder injury and complex extraperitoneal bladder injury in two patients. 75-year-old woman with intraperitoneal bladder rupture after motor vehicle collision. CT cystogram shows defect in anterior bladder wall (arrow) as well as intraperitoneal contrast material outlining pelvic peritoneal reflections.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —Intraperitoneal bladder injury and complex extraperitoneal bladder injury in two patients. 60-year-old woman after motor vehicle collision. Contrast extravasation from complex extraperitoneal rupture is extending high into pelvis in space of Retzius.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —Various types of urethral trauma in three patients. 54-year-old man after straddle injury. Voiding cystourethrogram shows partial urethral transection and extravasation at bulbar urethra (type 5 injury, arrow).

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —Various types of urethral trauma in three patients. 23-year-old man after motor vehicle collision. Pericatheter voiding cystourethrogram obtained a few days after admission shows leakage of urine above urogenital diaphragm (type 2 injury, arrow). Note left pubic fractures and pear-shaped bladder caused by presence of surrounding hematoma.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11C —Various types of urethral trauma in three patients. 58-year-old male pedestrian struck by car. Enhanced CT scan shows balloon of Foley catheter positioned anterior to prostate and lateral to urethra (arrow). Note right pubic fracture and urine and hematoma in periprostatic space.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —44-year-old man who heard popping sound during sexual intercourse. Transverse sonogram of penis shows defect in tunica albuginea of left corpus cavernosum (arrows) and large surrounding hematoma.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —44-year-old man who heard popping sound during sexual intercourse. Photograph of penis shows ecchymosis, giving "eggplant" appearance to penis.

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