Diagnostic accuracy of pneumo-CT-cystography in the detection of bladder rupture in patients with blunt pelvic trauma
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ABDOMINAL RADIOLOGY
Diagnostic accuracy of pneumo‑CT‑cystography in the detection of bladder rupture in patients with blunt pelvic trauma Margherita Trinci1 · Vincenzo Cirimele2 · Diletta Cozzi3 · Michele Galluzzo1 · Vittorio Miele3 Received: 30 January 2020 / Accepted: 30 March 2020 © Italian Society of Medical Radiology 2020
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. Keywords Emergency radiology · Computed tomography · Ultrasound · Bladder rupture
Introduction Genitourinary injuries are frequent complications of abdomino-pelvic trauma and occur in 15–20% of pelvic fractures cases, especially if pubic symphysis is involved [1–3]. Urinary bladder rupture is a relatively frequent injury in blunt abdomino-pelvic trauma, occurring in 1–6% of patients [4–10]. Due to its deep position within the bony pelvis, the bladder is well protected against both blunt and penetrating traumatic traumas. Bladder rupture represents an important injury, because the reported mortality rate after blunt trauma is substantial (22%) [11]. Bladder injuries * Diletta Cozzi [email protected] 1
Department of Emergency Radiology, S. Camillo Forlanini Hospital, Rome, Italy
2
Diagnostic Imaging Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
3
Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, Florence, Italy
have been classified into five types, which are resumed in Table 1 (Table 1) [4]. It is crucial to identify properly the type of bladder injury, since it is the key point for treatment’s choice [12, 13]. Types I, III and IV may be managed conservatively with a Foley catheter [5]. Types II and V require surgical treatment because of the risk of peritoneal sepsis [4, 14–16]. Multidete
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