Presentation
Known hypertensive with type 2 diabetic. History of a fall (slipped on the bathroom tiles) which led to severe left lower limb pain, hematuria and dysuria. Anticoagulated with apixaban.
Patient Data
An echogenic, irregular shaped mobile bladder mass measuring, 8.8 x 3.0 x 6.4 cm consistent with bladder hematoma. Fine intraluminal echogenic debris are also demonstrated.
The urinary bladder is fully distended, air lobules are noted in anterosuperior aspect. The catheter tip with inflated balloon is noted to be in situ in the urethra. A pyramid shaped hyperdense area is noted within the bladder. The apex of the "pyramid" is oriented anteroposteriorly with the base of the pyramid being posteriorly. The ureters are normal.
The right kidney has a duplex system (upper pole and lower pole moiety) with stasis of contrast noted at the vesicoureteral junction. Left kidney has a small upper pole calculi and a small midpole cyst, Bosniak class I cyst. Mild bilateral perinephric fat stranding.
There are generalized aortic atheromatous changes. Diverticuli at the sigmoid colon. Comminuted displaced fracture of the supratrochanteric neck of left femur. There are vertebral compression fractures of T11 and L1 more marked at the latter.
There are bi-basal linear atelectatic changes at the lung bases. There is a small inguinal hernia.
The catheter balloon is demonstrated in situ. There is an echogenic, mobile, thick ,avascular debris noted at the base of the urinary bladder measuring 3.0 x 2.0 x 1.5 cm. No bladder debris demonstrated. The prostate gland is enlarged measuring 34.5 mL.
Case Discussion
This is a case of trauma in a patient who is anticoagulated. Radiological findings demonstrate an intraluminal bladder hematoma, present prior to indwelling catheter (IDC) insertion. Bladder hematoma is typically associated with high-energy trauma, exact details regarding the fall are not known. Anticoagulants are known to increase the risk of excessive bleeding due to inhibition of thrombin-induced platelet activation.
A three-way IDC for continuous bladder irrigation (CBI) to clear the hematoma and debris. Imaging post irrigation demonstrated significant interval reduction in the hematoma. He also had a total left hip replacement for the left neck of femur fracture.
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