High rising flames: a sign of complex extraperitoneal bladder rupture

Area of Science:

• Urology
• Radiology
• Trauma Surgery

Background:

• Extraperitoneal bladder rupture is the most common bladder injury after pelvic trauma, occurring in 80-90% of cases.
• Computed tomography (CT) cystography typically shows contrast extravasation confined to the perivesical space with a flame-shaped appearance.

Purpose of the Study:

• To report an unusual CT cystogram finding in a patient with complex extraperitoneal bladder rupture and associated pelvic fracture urethral distraction defect.
• To highlight the extended pattern of contrast extravasation beyond the typical perivesical space.

Main Methods:

• A case report detailing imaging findings from a CT cystogram.
• Description of the anatomical location and extent of contrast extravasation.

Main Results:

• The CT cystogram revealed a complex extraperitoneal bladder rupture with a pelvic fracture and urethral distraction defect.
• Unusually large-volume contrast extravasation extended beyond the perivesical space into the left perinephric region, mimicking high rising flames.

Conclusions:

• This case demonstrates an atypical presentation of extraperitoneal bladder rupture with extensive contrast spread.
• Imaging findings can vary significantly, and radiologists should be aware of unusual patterns of extravasation in pelvic trauma.