Computerized tomography cystography for the diagnosis of traumatic bladderrupture

Purpose: We present our experience with computerized tomography (CT) cystog raphy for diagnosing bladder rupture in patients with blunt abdominal and p elvic trauma, and compare the results of CT cystography with those of surgi cal exploration. Materials and Methods: We identified all patients with blunt trauma diagnos ed with bladder rupture from 1992 to September 1998. We reviewed the radiol ogy computerized information system for all CT cystography performed to eva luate blunt trauma during the same period. We also reviewed the medical rec ords and pertinent radiographic studies of patients with bladder rupture wh o underwent CT cystography as part of the hospital admission evaluation. Op erative and radiographic findings were compared. Results: CT cystography was performed in 316 patients as part of the initia l evaluation of blunt trauma. Of the 44 patients with the ultimate diagnosi s of bladder rupture CT cystography revealed bladder rupture in 42, while 2 3 of the 28 (82%) who underwent formal bladder exploration had operative fi ndings that exactly matched the CT cystography interpretation in terms of t he presence and type of rupture. In the 316 patients CT cystography detecte d bladder rupture with an overall sensitivity and specificity of 95% and 10 0%, respectively. For intraperitoneal rupture sensitivity was 78% and speci ficity was 99%. Conclusions: CT cystography provides expedient evaluation of bladder ruptur e due to blunt trauma and has accuracy comparable to that reported for plai n film cystography. We recommend CT cystography over plain film cystography in patients undergoing CT for other injuries associated with blunt trauma.