CT cystography

Last revised by Calum Worsley on 4 Oct 2021

CT cystography is a variation of the traditional fluoroscopic cystogram. Instead of anterograde opacification of the urinary collecting system (as with CT urography), contrast is instilled retrograde into the patient's bladder, and then the pelvis is imaged with CT.

  • suspected bladder rupture
    • fluoroscopic and CT cystography are considered equivalent for this indication 2

    • nevertheless, CT cystography has the advantage of visualizing other abdominopelvic injuries in the trauma patient within the same study avoiding unnecessary transfer to fluoroscopy suite

  • postoperative bladder/suspected bladder leak
  • urine is drained from the bladder via a Foley catheter or suprapubic catheter
  • a bag of dilute water-soluble contrast (e.g. Cystografin) is hung to instill contrast into the bladder under gravity pressure
    • dilution ratio of 1:10 is often used
  • similar to conventional cystography, contrast is instilled until the patient feels a strong urge to void (or ≥300 mL has been administered)
  • perform CT of the pelvis with thin sections
    • if the entire abdomen is to be performed, then this is performed first and the bladder is filled for CT cystogram afterwards

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Cases and figures

  • Case 1: contained bladder leak
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  • Case 2: vesico-vaginal fistula
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  • Case 3: extraperitoneal bladder rupture
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