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Radiographics SeptemberOctober 2000 Volume 20 Number 5


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CT Cystography in the Evaluation of Major Bladder Trauma


Jonathan P. Vaccaro, MD Jeffrey M. Brody, MD Presented by Seyed Amir Ebrahimzadeh

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CT cystography

CT cystography

classification scheme for bladder injury based on:


1. 2. 3.

The degree of wall injury Anatomic location Demonstrated characteristic imaging features for each type of injury

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CT cystography

CT cystography with retrograde bladder distention(150-300cc) replacing radiography Diagnostic accuracy approaching 100% CT scan with intravenous administrated contrast is not feasible because of increased scan time to 30min for delay scans 50 mL of Hypaque 60 [Nycomed, Princeton,NJ] and 450 mL of normal saline solution

Postdrainage images through the decompressed bladder are not 4/29/12 required

CT cystography
CT

cystography is routinely considered in

1. 2. 3.

Known pelvic fractures Gross hematuria Severe pelvic trauma with no known pelvic fractures

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Classification

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Surgery or conservative management?

Type 2 and 5 need surgery Type 1 and 3 manage conservatively Type 4 manage conservatively if urine clear of blood,cathater function well and blader neck is not injured.otherwise surgery is prefered.

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Type 1

Contusion are normal in CT cystography

Findings

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Type 2
10%20% Direct

of major bladder injuries

blow to the already distended bladder contrast material Around bowel loops, Between mesenteric folds, In the paracolic gutters.

Intraperitoneal 1. 2. 3.

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Type 2

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Type 3
An

intramural or partial-thickness laceration with intact serosa

intramural

hemorrhage and submucosal extravasation of contrast material without transmural extension.

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Type 3

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Type 4
Usually

caused by penetrating trauma

In

blunt trauma, the presumed mechanism is direct laceration of the bladder by bone fragments from a pelvic fracture is confined to

a.Simple:Extravasation

the perivesical space


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Type 4a

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Type 4b

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Type 4b

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Type 5
Combined

intra-and extraperitoneal rupture that are typical for both types

patterns

of injury

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Type 5

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Type 5: Combined Rupture?

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NO,its type 4b
Contrast

material is seen in the properitoneal space (extraperitoneal subserous tissue) of the right lower quadrant. should not be confused with intraperitoneal contrast material.

This

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Type 4b

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Thank you for your attention


Any

question?

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