From the Guidelines
A CT scan of the abdomen and pelvis without contrast is appropriate for evaluating a bladder wall hematoma, as it can depict blood and localize areas of bleeding, especially in patients with compromised renal function or potential need for further intervention with angiography. This approach is supported by the American College of Radiology, as stated in their appropriateness criteria for suspected retroperitoneal bleed 1. The key benefits of non-contrast CT in this context include:
- Speed and high spatial resolution
- Ability to scan large areas and localize the source of bleeding
- Noninvasiveness
- Helpful in patients with compromised renal function or when there is concern for additional contrast load
- Attenuation of the hematoma on non-contrast CT can help determine the relative acuity of the bleeding. However, limitations of CT include the inability to simultaneously intervene, and small hematomas or those that have begun to resolve may be less conspicuous on non-contrast studies 1. If the clinical suspicion remains high despite negative findings on non-contrast CT, additional imaging such as cystoscopy or contrast-enhanced studies might be considered as follow-up. The scan should include thin-slice imaging through the pelvis with multiplanar reconstructions to properly visualize the bladder wall, as this will provide the best opportunity to identify the hematoma and assess its size and location.
From the Research
CT Abd/Pelvis for Bladder Wall Hematoma without Contrast
- The use of CT scans in detecting bladder wall hematomas is a topic of interest, with various studies exploring its effectiveness 2, 3.
- A study published in 2020 discussed the role of CT cystography in evaluating bladder injuries, highlighting its comparable accuracy to conventional cystography 2.
- Another study from 2018 presented a case of an intraluminal urinary bladder hematoma masquerading as a neoplastic mass, where FDG PET CT was helpful in diagnosing it as a non-neoplastic mass 3.
- However, the specific use of CT abd/pelvis without contrast for bladder wall hematoma is not directly addressed in these studies.
- A 2003 study developed an image processing algorithm to aid in the detection of bladder tumors using CT scans, achieving high sensitivity and specificity 4.
- Additionally, a 2012 study recommended CT urography as the initial imaging test for hematuria in patients at high-risk for urothelial cell carcinoma, but this may not be directly applicable to the use of CT abd/pelvis without contrast for bladder wall hematoma 5.
- A 2018 study and a 2024 study discussed the use of other imaging modalities such as ultrasound and CEUS in detecting bladder lesions and hematomas, but did not specifically address the use of CT abd/pelvis without contrast 3, 6.