Wednesday Image Review

From the Archives: What’s the Diagnosis? By Dr. Katie Selman

A 76 yo female presents after a fall down several stairs. She is diagnosed with bilateral pubic rami fractures on x-ray. The patient has difficulty with urination. A foley is placed and there is blood return. A CT cystogram is shown below. What’s the diagnosis?

Answer: Bladder injury (extraperitoneal)

  • Occurs with direct blunt trauma to distended bladder
    • 70-97% associated with pelvic fractures
  • Clinically, patient will have gross hematuria, lower abdominal tenderness, perineal or scrotal edema, difficulty voiding
  • Gold standard diagnosis: retrograde cystogram (either x-ray or CT)
    • Can be missed on routine CT or US
  • Intraperitoneal rupture: contrast material leaks into peritoneal cavity
    • Require surgical repair
  • Extraperitoneal rupture: contrast material leaks into retroperitoneum
    • Most common
    • Usually managed conservatively and heal within 2 weeks


Gratton MC, French L. Genitourinary Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eNew York, NY: McGraw-Hill; 2016.

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