Extraperitoneal bladder rupture


Typical findings of extraperitoneal bladder rupture following severe pelvic trauma. This case highlights the importance of performing a proper cystogram following trauma, as the bladder was suboptimally evaluated on the original delayed images.  I would imagine that even later delays with more bladder volume may not have confidently shown the small areas of leakage anteriorly. The blood tracking along the left ureter was likely related to pelvic fractures rather than injury of the left ureter.

The pattern of asymmetry of renal enhancement and excretion of contrast on the delayed images is unexpected. The right kidney appears to have a persistent nephrogram, typically seen in the setting of acute renal injury, but without a definite cause. The left kidney has expected excretion of contrast despite blood products surrounding the left ureter. It would be reasonable to recommend laboratory and/or functional imaging follow-up depending on clinical concern. 

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