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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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3.CT cystography  CT cystography classification scheme for bladder injury based on: 1. The degree of wall injury Anatomic location Demonstrated characteristic imaging features for each type of injury 4/29/12 . 2.

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.NJ] and 450 mL of normal saline solution     Postdrainage images through the decompressed bladder are not 4/29/12 required . Princeton.

2. 3.CT cystography  CT cystography is routinely considered in 1. Known pelvic fractures Gross hematuria Severe pelvic trauma with no known pelvic fractures 4/29/12 .

Classification 4/29/12 .

cathater function well and blader neck is not injured.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.otherwise surgery is prefered.   4/29/12 .

Type 1  Contusion are normal in CT cystography  Findings 4/29/12 .

Between mesenteric folds. In the paracolic gutters. 4/29/12 . 2.Type 2  10%–20%  Direct of major bladder injuries blow to the already distended bladder contrast material Around bowel loops. 3.  Intraperitoneal 1.

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Type 2 4/29/12 .

4/29/12 .Type 3  An intramural or partial-thickness laceration with intact serosa  intramural hemorrhage and submucosal extravasation of contrast material without transmural extension.

Type 3 4/29/12 .

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 4/29/12 .

Type 4a 4/29/12 .

Type 4b 4/29/12 .

Type 4b 4/29/12 .

Type 5  Combined intra-and extraperitoneal rupture that are typical for both types  patterns of injury 4/29/12 .

Type 5 4/29/12 .

Type 5: Combined Rupture? 4/29/12 .

should not be confused with intraperitoneal contrast material.  This 4/29/12 .NO.it’s type 4b  Contrast material is seen in the properitoneal space (extraperitoneal subserous tissue) of the right lower quadrant.

Type 4b 4/29/12 .

Thank you for your attention  Any question? 4/29/12 .

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