Traumatic urinary bladder rupture: the usefulness of CT cystography

A 38-year-old male presented at the emergency unit with acute abdominal pain and massive hematuria after a fall in the stairs of his home. At physical examination, tenderness was found in the hypogastric area and in both right and left iliac regions. The first radiological investigation performed was ultrasonography (Fig. A). Free liquid was found in the Morisson pouch, in the perihepatic-space and in the perisplenic fossa. The bladder contained blood clots and there was no liquid in the Douglas pouch. Active bleeding was not excluded. Unenhanced and contrast-enhanced CT of the abdomen in arterial, venous and late phase was performed and large amount of intraperitoneal liquid was confirmed but without evident cause (Fig. B). There were no visceral injuries neither skeletal lesion nor vascular lesion. 60 minutes later, an additional cystography phase was performed and revealed a rupture in the superior aspect of the bladder with intraperitoneal spilling of contrast (Fig. C and D). Consequently, the patient was admitted for surgical repair of the bladder defect.