(B) EP injury with contrast tracking giving the appearance of int

(B) EP injury with contrast tracking giving the appearance of intraperitoneal contrast extravasation. Figure 4 (A) Intraperitoneal (IP) contrast on computed tomography image of the abdomen. (B) IP contrast detected on retrograde cystogram. Table 1 Radiologic Classification System7 Table 2 Bladder Injury Severity Scale8 Diagnosis Gross hematuria is the most common sign associated with bladder rupture. It has been reported in 100% of all

bladder injuries and its presence in conjunction with pelvic trauma is a well-documented predictor of injury. Other signs and symptoms include abdominal or suprapubic tenderness, shock, abdominal distension, inability to urinate, microscopic hematuria (5% of patients),6 and blood at Inhibitors,research,lifescience,medical the meatus. Guidelines for diagnostic imaging have been refined

over recent years, and studies have identified patients at highest risk of injury in an attempt to reduce the number of unnecessary, time-consuming, and costly investigations. An absolute indication for cystographic imaging is the presence Inhibitors,research,lifescience,medical of gross hematuria in conjunction with pelvic fracture. Relative indications for cystography are gross hematuria without pelvic fracture and microscopic hematuria with pelvic fracture (especially if > 165 × 106 red blood cells [RBC]/L). Several series have shown that hematuria Inhibitors,research,lifescience,medical of > 165 × 106 RBC/L identifies those at greatest risk of bladder injury.2 However, microscopic hematuria in general is a poor indicator of the presence of bladder rupture and cystography should not be routinely performed in patients who have BAY 73-4506 nmr microhematuria alone. Avey and colleagues

noted that, in 687 patients with pelvic Inhibitors,research,lifescience,medical fracture and no bladder injury, only 196 (27.1%) of them had negative urinalysis results.2 The presence of gross hematuria without pelvic fracture has been investigated by Fuhrman and colleagues, who prospectively showed that no bladder injuries were found in all 25 patients that were imaged.9 However, if 25% of IP ruptures occur without pelvic fracture, the use of cystography in these patients when clinical suspicion Inhibitors,research,lifescience,medical is high is appropriate. Static cystography is quick and cost efficient. It should be performed oxyclozanide only after concomitant urethral injury has been excluded. A scout radiograph of the abdomen is taken and 100 mL of 20% to 30% contrast material is injected through a urethral or suprapubic catheter to ensure gross extravasation is not present. Then, 200 to 250 mL of contrast material is administered and an abdominal film is obtained. It is vital that a scout, filled, and postdrainage radiograph are taken to visualize contrast that has extravasated behind the distended bladder; 10% of bladder injuries are diagnosed on the postdrainage radiograph. 7 A computed tomography (CT) scan of the abdomen and pelvis has become a routine investigation in high-energy blunt trauma. As a result, CT cystograms are being performed more often with comparable results in some studies.

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