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Age: 33

Sex: Male

Indication: Trauma

Save ("V")

Case #6


Findings

  • Chest
    • Residual thymic tissue in the anterior mediastinum
  • Abdomen/Pelvis
    • Wall thickening of the anterosuperior bladder with a possible focal defect and adjacent small amount of low density free intraperitoneal fluid layering dependently in the pelvis
    • Cholecystectomy
    • Right femoral approach venous catheter with tip in the right common iliac vein
  • MSK
    • No acute fracture
  • CT cystogram
    • Defect in the anterosuperior bladder with contrast spillage into the peritoneal cavity, layering dependently in the pelvis


Diagnosis

  • Intraperitoneal bladder rupture

Sample Report

CT Trauma CAP:

Findings concerning for intraperitoneal bladder with a likely focal defect along the anterosuperior bladder wall. Recommend CT cystogram for further evaluation.

CT Cystogram:

Intraperitoneal bladder rupture with a defect in the anterosuperior bladder wall.


Discussion

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Images

Irregular thickening of the bladder dome with a small defect in the anterosuperior wall (red arrow) concerning for intraperitoneal bladder rupture. Subsequent CT cystogram confirmed intraperitoneal bladder rupture with site of leak in the anterosuperior bladder wall (red arrow). Companion case of extraperitoneal bladder rupture showing the molar tooth sign (red outline) of contrast encircling the bladder on three sides, but conspicuously absent along the posterior margin (red arrow) in the inferior extent of the peritoneal space. Companion case of extraperitoneal bladder rupture showing extensive contrast leakage in the prevesical space (red arrows), but no contrast in the peritoneal cavity, including in the rectouterine space aka Pouch of Douglas (yellow arrow).



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