Abstract
Purpose
To evaluate the diagnostic utility of bladder air distension (pneumo-CT-cystography) in the detection of bladder rupture in patients with blunt pelvic trauma.
Materials and methods
843 patients with blunt pelvic trauma were evaluated. Intravenous contrast-enhanced CT was performed for trauma staging. 97 of 843 patients had clinical and radiological signs of possible bladder injury and underwent retrograde air distension.
Results
Among 97 patients, 31/97 showed CT signs of bladder rupture, of which 5/31 (16%) intraperitoneal, 25/31 (81%) extraperitoneal and 1/31 (3%) combined. 23 of these patients underwent surgery, which confirmed bladder injury in 100% of cases. The other 8 patients were managed conservatively, and follow-up studies showed disappearance of free air. Among the 66/97 patients with no signs of bladder injury, 38/66 had surgery, which confirmed bladder integrity, while 28/66 were managed conservatively and showed no signs of bladder rupture at clinico-radiological follow-up examinations.
Conclusions
CT evaluation of urinary bladder after retrograde air distension (pneumo-CT-cystography) may be a reliable diagnostic tool in the detection of bladder rupture in patients with blunt pelvic trauma. This technique is faster, cheaper and allows to overcome some of the limitations of conventional CT-cystography.
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References
McCormack R, Strauss EJ, Alwattar BJ, Tejwani NC (2010) Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis 68(4):281–291
Coccolini F, Stahel PF, Montori G et al (2017) Pelvic trauma: WSES classification and guidelines. World J Emerg Surg 12:5. https://doi.org/10.1186/s13017-017-0117-6
Trinci M, Cirimele V, Ferrari R, Ianniello S, Galluzzo M, Miele V (2019) Diagnostic value of contrast-enhanced ultrasound (CEUS) and comparison with color Doppler ultrasound and magnetic resonance in a case of scrotal trauma. J Ultrasound. https://doi.org/10.1007/s40477-019-00389-y
Power N, Ryan S, Hamilton P (2004) Computed tomographic cystography in bladder trauma: pictorial essay. J Assoc Can Radiol 55(5):304–308
Carroll PR, McAninch JW (1984) Major bladder trauma: mechanisms of injury and a unified method of diagnosis and repair. J Urol 132(2):254–257. https://doi.org/10.1016/s0022-5347(17)49581-4
Chan DPN, Abujudeh HH, Cushing GL, Novelline R (2006) CT Cystography with Multiplanar Reformation for Suspected Bladder Rupture: Experience in 234 Cases. Am J Roentgenol 187(5):1296–1302. https://doi.org/10.2214/AJR.05.0971
McCort JJ, Mindelzun RE (1994) Bladder injury and pelvic fractures. Emerg Radiol 1(1):47–51. https://doi.org/10.1007/BF02628776
Cozzi D, Verrone GB, Agostini S, Bartolini M, D'Amico G, Pradella S et al (2019) Acute penile trauma: imaging features in the emergency setting. Radiol Med 124(12):1270–1280. https://doi.org/10.1007/s11547-019-01065-1
Durrant JJ, Ramasamy A, Salmon MS, Watkin N, Sargeant I (2013) Pelvic fracture-related urethral and bladder injury. J R Army Med Corps 159(suppl 1):i32–i39. https://doi.org/10.1136/jramc-2013-000025
Ramchandani P, Buckler PM (2009) Imaging of genitourinary trauma. Am J Roentgenol 192(6):1514–1523. https://doi.org/10.2214/AJR.09.2470
Iverson AJ, Morey AF (2001) Radiographic evaluation of suspected bladder rupture following blunt trauma: critical review. World J Surg 25(12):1588–1591. https://doi.org/10.1007/s00268-001-0154-9
Corriere JN, Sandler CM (1999) Bladder rupture from external trauma: diagnosis and management. World J Urol 17(2):84–89. https://doi.org/10.1007/s003450050111
Elliott SP, McAninch JW (2009) Extraperitoneal bladder trauma: delayed surgical management can lead to prolonged convalescence. J Trauma 66(1):274–275. https://doi.org/10.1097/01.ta.0000221077.72033.75
Iselin CE, Rohner S, Tuchschmid Y, Schmidlin F, Graber P (1996) Laparoscopic repair of traumatic intraperitoneal bladder rupture. Urol Int 57(2):119–121. https://doi.org/10.1159/000282893
Corriere JN, Sandler CM (1986) Management of the ruptured bladder: seven years of experience with 111 cases. J Trauma 26(9):830–833
Elkbuli A, Ehrhardt JD, Hai S, McKenney M, Boneva D (2019) Management of blunt intraperitoneal bladder rupture: Case report and literature review. Int J Surg Case Rep 55:160–163. https://doi.org/10.1016/j.ijscr.2019.01.038
Cozzi D, Bertelli E, Savi E, Verna S, Zammarchi L, Tilli M et al (2019) Ultrasound findings in urogenital schistosomiasis: a pictorial essay. J Ultrasound. https://doi.org/10.1007/s40477-019-00405-1
Trinci M, Piccolo CL, Ferrari R, Galluzzo M, Ianniello S, Miele V (2019) Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma. J Ultrasound 22(1):27–40. https://doi.org/10.1007/s40477-018-0346-x
Tagliati C, Argalia G, Graziani B, Salmistraro D, Giuseppetti GM, Giovagnoni A (2019) Contrast-enhanced ultrasound in the evaluation of splenic injury healing time and grade. Radiol Med 124(3):163–169. https://doi.org/10.1007/s11547-018-0954-8
Tagliati C, Argalia G, Polonara G, Giovagnoni A, Giuseppetti GM (2019) Contrast-enhanced ultrasound in delayed splenic vascular injury and active extravasation diagnosis. Radiol Med 124(3):170–175. https://doi.org/10.1007/s11547-018-0961-9
Vaccaro JP, Brody JM (2000) CT cystography in the evaluation of major bladder trauma. Radiogr Rev Publ Radiol Soc N Am Inc 20(5):1373–1381. https://doi.org/10.1148/radiographics.20.5.g00se111373
Deck AJ, Shaves S, Talner L, Porter JR (2000) Computerized tomography cystography for the diagnosis of traumatic bladder rupture. J Urol 164(1):43–46
Hsieh C-H, Chen R-J, Fang J-F et al (2002) Diagnosis and management of bladder injury by trauma surgeons. Am J Surg 184(2):143–147. https://doi.org/10.1016/s0002-9610(02)00913-3
Deck AJ, Shaves S, Talner L, Porter JR (2001) Current experience with computed tomographic cystography and blunt trauma. World J Surg 25(12):1592–1596. https://doi.org/10.1007/s00268-001-0155-8
Quagliano PV, Delair SM, Malhotra AK (2006) Diagnosis of blunt bladder injury: A prospective comparative study of computed tomography cystography and conventional retrograde cystography. J Trauma 61(2):410–421. https://doi.org/10.1097/01.ta.0000229940.36556.bf
Fouladi DF, Shayesteh S, Fishman EK, Chu LC (2019) Imaging of urinary bladder injury: the role of CT cystography. Emerg Radiol. https://doi.org/10.1007/s10140-019-01739-3
Heller MT, Oto A et al (2019) ACR Appropriateness Criteria® Penetrating Trauma-Lower Abdomen and Pelvis. J Am Coll Radiol JACR 16(11):S392–S398. https://doi.org/10.1016/j.jacr.2019.05.023
Scott MH, Porter JR (1997) Extraperitoneal bladder rupture: pitfall in CT cystography [clinical-conference]. AJR Am J Roentgenol 168(5):1232. https://doi.org/10.2214/ajr.168.5.9129417
Sivit CJ, Cutting JP, Eichelberger MR (1995) CT diagnosis and localization of rupture of the bladder in children with blunt abdominal trauma: significance of contrast material extravasation in the pelvis. AJR Am J Roentgenol 164(5):1243–1246. https://doi.org/10.2214/ajr.164.5.7717239
Pistoia F, Markowitz SK, Sussman SK (1989) Contrast material in posterior vaginal fornix mimicking bladder rupture: CT features. J Comput Assist Tomogr 13(1):153–155
Spencer Netto FAC, Hamilton P, Kodama R et al (2008) (2008) Retrograde urethrocystography impairs computed tomography diagnosis of pelvic arterial hemorrhage in the presence of a lower urologic tract injury. J Am Coll Surg 206(2):322–327. https://doi.org/10.1016/j.jamcollsurg.2007.07.025
Vining DJ, Zagoria RJ, Liu K, Stelts D (1996) CT cystoscopy: an innovation in bladder imaging. AJR Am J Roentgenol 166(2):409–410. https://doi.org/10.2214/ajr.166.2.8553956
Merkle EM, Wunderlich A, Aschoff AJ et al (1998) Virtual cystoscopy based on helical CT scan datasets: perspectives and limitations. Br J Radiol 71(843):262–267
Gualdi GF, Casciani E, Rojas M, Polettini E (1999) Virtual cystoscopy of bladder neoplasms Preliminary experience. Radiol Med 97(6):506–509
Panebianco V, Osimani M, Lisi D et al (2009) 64-detector row CT cystography with virtual cystoscopy in the detection of bladder carcinoma: preliminary experience in selected patients. Radiol Med 114(1):52–69. https://doi.org/10.1007/s11547-008-0350-x
Amin MF, Abd El Hamid AM (2013) The diagnostic accuracy of multidetector computed tomography with multiplanar reformatted imaging and virtual cystoscopy in the early detection and evaluation of bladder carcinoma: comparison with conventional cystoscopy. Abdom Imaging 38(1):184–192. https://doi.org/10.1007/s00261-012-9902-6
Basak M, Ozkurt H, Tanriverdi O, Cay E, Aydin M, Miroglu C (2009) Sixteen-slice multidetector computed tomographic virtual cystoscopy in the evaluation of a patient with suspected bladder tumor and history of bladder carcinoma operation. J Comput Assist Tomogr 33(6):867–871. https://doi.org/10.1097/RCT.0b013e318199d6da
Elawady H, Mahmoud MA, Mostafa DMA, Abdelmaksoud A, Safa MW, Elia RZ (2016) Computed tomography virtual cystoscopy for follow-up of patients with superficial bladder tumours in comparison to conventional cystoscopy: an exploratory study. Arab J Urol 14(3):192–197. https://doi.org/10.1016/j.aju.2016.06.003
Kalokairinou K, Ploumidis A, Kalogeropoulos T et al (2014) The role of virtual cystoscopy, after multidetector computed tomography imaging reconstruction without the use of contrast medium, in the diagnosis and evaluations of bladder tumors: preliminary study. Adv Urol. https://doi.org/10.1155/2014/923958
Morey AF, Iverson AJ, Swan A et al (2001) Bladder rupture after blunt trauma: guidelines for diagnostic imaging. J Trauma 51(4):683–686. https://doi.org/10.1097/00005373-200110000-00010
Morgan DE, Nallamala LK, Kenney PJ, Mayo MS, Rue LW (2000) CT cystography: radiographic and clinical predictors of bladder rupture. AJR Am J Roentgenol 174(1):89–95. https://doi.org/10.2214/ajr.174.1.1740089
Lynch TH, Martínez-Piñeiro L, Plas E et al (2005) EAU guidelines on urological trauma. Eur Urol 47(1):1–15. https://doi.org/10.1016/j.eururo.2004.07.028
Gomez RG, Ceballos L, Coburn M et al (2004) Consensus statement on bladder injuries. BJU Int 94(1):27–32. https://doi.org/10.1111/j.1464-410X.2004.04896.x
Joshi G, Kim EY, Hanna TN, Siegel CL, Menias CO (2018) CT cystography for suspicion of traumatic urinary bladder injury: indications, technique, findings, and pitfalls in diagnosis: RadioGraphics Fundamentals | Online Presentation. RadioGraphics 38(1):92–93. https://doi.org/10.1148/rg.2018170125
Haroon SA, Rahimi H, Merritt A, Baghdanian A, Baghdanian A, LeBedis CA (2019) Computed tomography (CT) in the evaluation of bladder and ureteral trauma: indications, technique, and diagnosis. Abdom Radiol. https://doi.org/10.1007/s00261-019-02161-6
Scardapane A, Pagliarulo V, Ianora AAS, Pagliarulo A, Angelelli G (2008) Contrast-enhanced multislice pneumo-CT-cystography in the evaluation of urinary bladder neoplasms. Eur J Radiol 66(2):246–252. https://doi.org/10.1016/j.ejrad.2007.06.005
Regine G, Atzori M, Buffa V, Miele V, Ialongo P, Adami L (2003) Virtual CT-pneumocystoscopy: indications, advantages and limitations Our experience. Radiol Med 106(3):154–159
American College of Surgeons, Committee on Trauma. Advanced Trauma Life Support: Student Course Manual 8th ed. American College of Surgeons, Chicago
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Trinci, M., Cirimele, V., Cozzi, D. et al. Diagnostic accuracy of pneumo-CT-cystography in the detection of bladder rupture in patients with blunt pelvic trauma. Radiol med 125, 907–917 (2020). https://doi.org/10.1007/s11547-020-01190-2
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DOI: https://doi.org/10.1007/s11547-020-01190-2