Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Section 6 Pelvis
- Case 69 Physiologic pelvic intraperitoneal fluid
- Case 70 Avoiding missed injuries to the bowel and mesentery: the importance of intraperitoneal fluid
- Obstetrics and gynecology
- Case 71 Endometrial hypodensity simulating fluid
- Case 72 Pseudogestational sac
- Case 73 Cystic pelvic mass simulating the bladder
- Case 74 Ovarian torsion
- Case 75 Urine jets simulating a bladder mass
- Case 76 Extraluminal bladder Foley catheter
- Case 77 Missed bladder rupture
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Case 77 - Missed bladder rupture
from Obstetrics and gynecology
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Section 6 Pelvis
- Case 69 Physiologic pelvic intraperitoneal fluid
- Case 70 Avoiding missed injuries to the bowel and mesentery: the importance of intraperitoneal fluid
- Obstetrics and gynecology
- Case 71 Endometrial hypodensity simulating fluid
- Case 72 Pseudogestational sac
- Case 73 Cystic pelvic mass simulating the bladder
- Case 74 Ovarian torsion
- Case 75 Urine jets simulating a bladder mass
- Case 76 Extraluminal bladder Foley catheter
- Case 77 Missed bladder rupture
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Summary
Imaging description
CT cystography (CTC) has replaced conventional fluoroscopic cystography for the evaluation of bladder rupture in trauma patients. The bladder is filled with diluted contrast using the Foley catheter to generate adequate distension. At our institution, we usually perform CTC immediately after venous phase CT scan by emptying the bladder, mixing 30 mL of iohexhol 350 mg/mL in a 500 cc bag of normal saline warmed to body temperature, connecting this to the Foley catheter using an intravenous “drip” set, and hanging the bag 40 cm above the symphysis pubis. We perform a low-dose CT scan through the pelvis after 350 mL of contrast has been administered, or contrast stops dripping, or when the patient cannot tolerate bladder distention. We routinely perform multiplanar reformations.
A markedly distended bladder (such as in a patient with chronic bladder outlet obstruction) may require considerably more than 350 cc of contrast to fill the bladder. If images do not demonstrate a distended oval-shaped bladder (e.g., a floppy bladder draping around adjacent structures) then the bladder is inadequately distended and has not been “stressed” adequately to evaluate for rupture.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Emergency RadiologyVariants and Other Difficult Diagnoses, pp. 255 - 257Publisher: Cambridge University PressPrint publication year: 2013