Misleading positioning of a Foley catheter balloon

Indwelling catheters in the urinary bladder are associated with numerous and various complications, e.g. infection, haemorrhage, epididymo-orchitis and perforation. Abdominopelvic CT is frequently performed in hospitalized patients, with the bladder being included in the examination. Familiarity with the various bladder pathologies and a routine and meticulous search for them are indicated in every case. Moreover, an awareness of certain pitfalls may prevent over-diagnosis and over-treatment. We present a case in which a Foley catheter balloon inflated in a bladder diverticulum simulates sealed bladder perforation with extraluminal location of the balloon. This potentially misleading diagnosis should be considered in the presence of apparent extraluminal position of catheter tip or balloon not substantiated by the clinical presentation.