Intraperitoneal bladder rupture
Motor vehicle collision.
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Bilateral pelvic ring, left acetabulum, and left sacral fractures.
Extraperitoneal pelvic hematoma distorting bladder contours.
Small amount of ascites.
Stranding about abdominal aorta and IVC.
Delayed images show intraperitoneal accumulation of contrast opacified urine. Careful review of the bladder dome (sagittal) indicates large linear area of rupture.
Important observations from this case:
- ascites with pelvic fractures should make you strongly suspicious for intraperitoneal bladder rupture
- you can carefully review the bladder dome and see the large, linear area of rupture even if delayed images are not obtained. This can be best seen on sagittal images, and is the most common location of injury
- delayed images help to confirm free intraperitoneal spillage of contrast opacified urine. However, a false negative study would be possible if the bladder did not contain sufficient volume