This document discusses urinary bladder trauma as evaluated by computed tomography (CT) cystography. It describes the five types of urinary bladder injury: contusion, intraperitoneal rupture, interstitial injury, extraperitoneal rupture, and combined rupture. CT cystography can accurately diagnose bladder injuries, demonstrating findings like hematomas, air in the bladder from filling, extravasated contrast material, and bladder wall thickening or disruption. Images show examples of intraperitoneal rupture with contrast between bowel loops, interstitial injury with lenticular bladder wall thickening, and extraperitoneal rupture appearing as "molar tooth" extravasated contrast in perivesical spaces.

2. An Article By
Dr. Ahmed Esawy
MBBS M.Sc MD

4. Urinary Bladder Trauma
•Is more frequent in blunt injuries.
•Conventional cystography has long been
considered the standard reference for
evaluation of bladder injury, and is
considered more senstive.
•The advance of CT cystography replaces
the conventional cystography in many
centers. It has a diagnostic accuracy
approaching 100 %.

5. Types of UB Trauma
Fives types of bladder injury are described
Type 1: Contusion
Type 2: Intraperitoneal Rupture
Type 3: Interstitial Injury
Type 4: Extraperitoneal Rupture
Type 5: Combined Rupture

6. INTRAPERITONEAL
RUPTURE

7. On a CT cystogram, an intravesical hematoma (arrow)
and a small focus of air introduced during bladder
filling are seen as filling defects.

8. Interstitial injury

9. CT cystogram demonstrates focal lenticular thickening of the bladder wall due to
interstitial hematoma and likely muscular disruption (black arrow), even material is seen
delineating the injury. Multiple pelvic fractures are also noted (white arrows)

10. Simple extraperitoneal
rupture

11. CT cystogram demonstrates extravasated contrast material confined to the
perivesical space within the extraperitoneal pelvis (arrows). The extravasated
contrast material demonstrates the typical "molar tooth" appearance

12. Complex
extraperitoneal
rupture

13. CT cystogram demonstrates extraperitoneal perivesicular
extravasation with the typical molar tooth appearance (solid arrows).
There is extension into the rectus abdominis muscle as well as the
superficial fatty layer (fascia of Camper) and deeper membranous layer
(Scarpa fascia) of the subcutaneous fascia (open arrow).

14. CT cystograms show diastasis of the pubis symphysis (arrowheads in a)
with disruption of the urogenital diaphragm, which allows contrast material
to extend directly into the deeper membranous subcutaneous fascial
planes and along the scrotal sub-dartos fascia (arrows).

15. Combined intraperitoneal & extraperitoneal Rupture
free contrast material delineating loops of
small bowel, a finding that is characteristic
of an intraperitoneal rupture.
contrast material insinuating itself into the
perivesical and perirectal spaces of the
extraperitoneal
pelvis (straight arrows). Pubic rami
fractures are also noted (curved arrow).

16. The arrows point to the presence of acute hematoma with its whorled-like appearance
within the confines of the urinary bladder. Also note the presence of fluid within the
peritoneal cavity compatible with ascites, a mixture of blood and urine.
INTRAPERITONEAL BLADDER RUPTURE WITH HEMATOMA WITHIN CONFINES OF BLADDER

17. CT cystogram demonstrates the classic appearance of an
intraperitoneal rupture, with extravasated contrast material
between loops of small bowel (arrows) and the anterior
pararenal fascia (arrowheads).

18. CT cystogram demonstrates
heterogeneous attenuation at the
bladder dome rupture site (arrow).

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