Following blunt abdominal trauma, peritoneal fluid on a CT scan with no evidence of solid organ damage can be a major diagnostic dilemma. Bladder rupture should be considered if nonhemorrhagic fluid is present in the abdomen on CT with no evidence of solid organ damage, after ruling out preexisting conditions such as cirrhosis or heart failure.
Delayed CT and CT cystography should be considered for further evaluation, as early recognition of bladder injury is crucial for appropriate surgical intervention.
Modern CT scanners scan the abdomen and pelvis within seconds of IV contrast administration, so bladder imaging is usually performed before the contrast is excreted into the renal collecting systems and ureters.
Imaging during the excretion phase is not routinely performed unless urinary tract injury is suspected. Extravasated urine in the peritoneum appears as simple peritoneal fluid when a patient has an intraperitoneal bladder rupture. (priest. 2021;13:e20479; https://bit.ly/3FWtfNJ; Chin J Traumatol. 2015;18:357; https://bit.ly/3G0B31a; Radiology. 2010;256:799.)
This clinical pearl first appeared onwww.EMedHome.com, which emails subscribers a new clinical pearl every Wednesday.
EMedHome.com on EM-News.com
Visit our website to watch videos from emergency medicine experts (http://bit.ly/EMN-EMedHomeVideos) and podcasts from Amal Mattu, MD, and other top emergency physicians from EMedHome.com (http://bit.ly/MattuEMN).
Video of the month
Robert Feldman, MD: Real cures for real EM problems: http://bit.ly/EMN-EMedHomeVideos. Dr. Feldman is an associate professor of emergency medicine at Rush University and an emergency physician at Cook County (Stroger) Hospital in Chicago.
Podcast of the month
Amal Mattu, MD, and colleagues: Hemoptysis, Elder Abuse and Aortic Stenosis: http://bit.ly/MattuEMN. Dr. Mattu is a top lecturer in emergency medicine, professor of emergency medicine, and vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.
Access links in REM reading this on our site: www.EM-News.com.
Comments? Write to us at [email protected].