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Imaging of Genitourinary Trauma
Imaging of Genitourinary Trauma
GENITOURINARY
TRAUMA
Urinary
Ureteral
Bladder
Urethral Testicular
Penile
Fracture
INTRODUCTION
• Unusual
• Incidence 0.15-4%
• Patients with adrenal gland trauma have a higher mortality rate than do
trauma patients without adrenal injury.
• The right adrenal gland is more vulnerable to injury for several reasons
RENAL TRAUMA
MDCT IVU
Evaluate UT (Renal vasculature,
CT may be not available
parenchyma, collecting system)
• Primary role :
Look for excretion and
– Asses the severity and extent of injury extravasation
– Evaluate the injured kidney for underlying
disorders
– Evaluate the anatomy and function of the
opposite kidney
– Assess for other associated injury
RENAL TRAUMA
Renal contusions • Areas of ill-defined decreased enhancement
A. Total absence of enhancement in left kidney, left renal artery (arrow) terminates abruptly
B. Large filling defect (white arrows) in left renal vein, contrast excretion into collecting system (black arrow)
RENAL TRAUMA MANAGEMENT
Minor Grades 1, 2 & 3
injuries (hemodynamica Delayed or
lly stable and secondary Surgical
Grade 4
show no hemorrhage (2- Management
Nonoperative devitalized 38 days later)
management fragments
1 Ureteral contusion
1 Bladder contusion
2 Intraperitoneal Rupture
3 Extraperitoneal Rupture
4 Combined injury
Characterizing
Bladder Injury
Conventional
(sensitivity 95% CT Cystography
Cystography
and specificity
100%)
A. VCUG shows partial urethral transection and extravasation at bulbar urethra (type 5)
B. VCUG shows leakage of urine above urogenital diaphragm (type 2)
C. Enhanced CT shows ballon of Folley catheter positioned anterior to prostate and lateral to urethra (arrow)
URETHRAL TRAUMA
- Obscuration of the
urogenital diaphragmatic fat - Assessing posttraumatic
plane pelvic anatomy
- Hematoma of the - Determining the position
ischiocavernosus and of the prostate and the
obturator internus muscles amount of pelvic fibrosis
- Obscuration of the - Estimating the length of
prostatic contour, and the prostatomembraneous
- Obscuration of the defect
bulbocavernosus muscle.
TESTICULAR TRAUMA
• US findings
– Heterogenous echotexture in the testis
– Testicular contour abnormality due to extrusion of the testes
– Testicular hematomas echotexture to be heterogeneous
– Hematomas varies with their age, show no internal vascularity
PENILE FRACTURE
Occurs Thrusting against
Excessive bending
exclusively with the pubic
of the erect penis
an erection symphisis
Rapid
Cracking sound Immediate pain
detumesence
Defect in tunica
albuginea
US or MRI
surrounding
hematoma
PENILE FRACTURE
A. Transverse sonogram of penis shows defect in tunica albuginea of left corpus cavernosum (arrows) and large surrounding hematoma.
B. Photograph of penis shows ecchymosis, “eggplant” appearance to penis.
THANK YOU
PERTANYAAN