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AP view from a cystogram showing a pear-shaped bladder.
Right superior pubic ramus fracture.
The contrast-filled bladder is becoming distorted in shape, with compression of the lateral walls leading to an apparent increase in the inferosuperior dimension of the bladder, or the so-called pear-shaped bladder appearance. The right superior pubic ramus is fractured, explaining the increase in pelvic fluid (hemorrhage) that would give this appearance to the bladder.