This week’s case involves a special procedure, so dust off your notes on contrast studies and take a look. As always, post your interpretations in the comments.
A single pre-contrast lateral view of the abdomen is available which reveals markedly decreased serosal detail and a wispy soft tissue density throughout the abdomen. A urinary catheter is present within the body of the bladder. The region of the bladder appears to be fat opacity which is likely due to the fat collections that normally surround it. The bladder itself is not visible.
A cystogram was performed with non-ionic, diluted contrast medium. Contrast medium initially fills the apex of the bladder, which has an irregular wall. On image two, the contrast begins leaking into the peritoneal space in the area of the trigone. The catheter was withdrawn slightly, and additional contrast extravasates on subsequent images.
Compared to the pre-cystogram image, the fluid in the peritoneal space has increased in opacity indicating contrast medium accumulation.
There is a plate on the left tibia and a femoral head osteotomy has been performed.
Urethral tear or avulsion with uroperitoneum
Sam Verstraete says
On the serie of lateral radio’s there is an abdominal loss of serosal contact, possible due to fluid-accumulation. In the mid abdominal regio there is an acccumulation of gas in the intestine, mainly in the caudal part of the jejunum and in the colon ascendens. An urinary catheder has been placed into the bladder and air has been blown into the bladder. There is leakage of air around the bladderwall. On the negative radio (without contrast) you can see the dorsal wall of the bladder surrounded with air in and outside the bladder. On the next radio’s contrast medium (liquid) is blown in the bladder. Possible IOHEXOLUM. On the first 3 contrast radio’s you can see the medium filling the normal bladder. Later on you see the leakage of the contrast-medium. On Image 4, you can actually see the holl, it’s an radiolucent holl, where the contrast is leaking out of the bladder.
So, there is an defect in the right midportion of the bladderwall.
On the DV-projection there is leakage of the contrast out of the bladder into the abdominal space. the caput of the left femur has been resected.
Rupture of urinary bladder. Probably secondary to prior trauma (hit by a car).