From the Guidelines
A CT scan of the abdomen and pelvis with intravenous contrast is the recommended imaging study for evaluating a suspected bladder wall hematoma, as it provides better tissue characterization and can visualize the entire pelvis to rule out other pathologies 1.
Key Considerations
- The patient should have their bladder adequately filled during the scan, which may require drinking water 30-60 minutes before the procedure or having a Foley catheter placed to instill contrast directly into the bladder.
- The CT scan will help determine the size, location, and extent of the hematoma, as well as identify any underlying causes such as trauma, infection, or malignancy.
- It can also detect complications like active bleeding or urinary obstruction.
Imaging Modality
- CT scan is preferred over ultrasound for bladder wall hematomas because it provides better tissue characterization and can visualize the entire pelvis to rule out other pathologies.
- A retrograde urethral and bladder opacification, ideally with a CT-scan, is suggested in severe pelvic trauma patients with clinical symptoms of lower urinary tract injury 1.
Special Considerations
- Patients with impaired renal function should have their kidney function assessed before receiving IV contrast.
- The radiation exposure from a single CT scan is generally considered acceptable given the diagnostic benefits in this clinical scenario.
Clinical Context
- The diagnosis of lower urinary tract injuries associated with pelvic fractures remains necessary to allow early drainage, and early surgical closure in case of intraperitoneal rupture, to limit complications and urinary sequelae 1.
- A contrast CT-scan of the abdomen and pelvis is the standard-of-care imaging workup in hemodynamically stable patients with severe pelvic trauma 1.
From the Research
CT Abd/Pelvis for Bladder Wall Hematoma
- The use of CT cystography has been evaluated in the diagnosis of bladder injury, including hematoma, in several studies 2, 3.
- A study published in 1999 found that CT cystography was an accurate method for evaluating bladder injury in patients with hematuria after blunt abdominal trauma 2.
- Another study published in 2020 discussed the role of CT cystography in the evaluation of bladder injuries, including its ability to provide comparable accuracy to conventional cystography 3.
- In terms of diagnosing bladder wall hematoma, a study published in 2018 found that a large hematoma can mimic a neoplastic mass in imaging modalities, but FDG PET CT can be helpful in diagnosing it as a non-neoplastic mass 4.
- Sonographic findings in bladder hematoma have also been described, including a large, echogenic thick, smooth rim and a laminated appearance with concentric layers of alternating hyperechogenicity and hypo-echogenicity 5.
- Incidentally detected bladder wall thickening on CT can also be suggestive of bladder malignancy, and further work-up including cystoscopy and urine cytology should be performed to assess bladder malignancy 6.