Presentation
Fall from a moving truck.
Patient Data
Multiple left-sided rib fractures, left clavicle fracture, left 9th transverse process fracture, and a small left hemopneumothorax with left intercostal drain in situ.
High-grade stenosis of the celiac trunk with minor poststenotic dilatation
Complex pubic rami and left sacral ala fracture with evidence of blood within the urinary bladder and extensive pelvic hematoma. Prominent enhancement at the left base of the penis may represent a vascular injury, however there is no significant change on portal venous and delayed phases. This injury has high correlation with urethral injury.
The Foley catheter balloon is inflated and lays in the fossa navicularis, around the level of the bulbous urethra diaphragm. There is an abrupt cut-off with extraperitoneal contrast extravasation. There is no evidence of extension into the posterior urethra or the bladder. These findings represent a traumatic urethral transection.
Residual contrast in the right hemi pelvis on the first image is due to a previous unsucessful contrast study attempt.
Case Discussion
Traumatic urethral transection secondary to pelvic fractures are not common but, when present, are associated with significant morbidity.
The injury occurs most commonly at the level of the bulbomembranous junction.
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