Pear-shaped bladder with bladder neck leak

On the scout image, a left-approach soft tissue drain is visible. No pelvic fracture.

After introduction of the Foley catheter, the bladder is filled with contrast and a cystogram obtained. The bladder has a vertical "pear-shaped" configuration. The walls do not appear trabeculated and the patient did not have a history of bladder outlet obstruction. The combination of the appearance and history is compatible with bilateral mass effect on the bladder, likely from a pelvic hematoma.

On continued filling of the bladder, a small bladder neck leak reveals itself.

The red arrow points to the bladder base injury with contrast leaking out of the right bladder neck. The catheter should be left in place to decompress the bladder and aid in recovery of the bladder neck injury.

Noncontrast CT images of the pelvis show a pelvic hematoma, disproportionately involving the extraperitoneal space anterior to the bladder (space of Retzius). The bladder is lengthened and narrowed, similar to the cystogram images, but the cystogram shows the bladder to better effect. The bladder base leak is not visible on the CT.

The patient is post drain placement into the pelvic fluid collection.