The Roentgen Diagnosis of Pelvic Extraperitoneal Effusion

Abstract

Extraperitoneal, perivesical pelvic effusions may be hemorrhagic or uriniferous, the latter resulting from extraperitoneal rupture of the bladder or disruption of the posterior urethra. The effusions may be recognized on anteroposterior radiographs of the pelvis by (a) displacement of the bladder (small effusion); (b) obliteration of the normal soft-tissue anatomy within the pelvis (moderate effusion); and (c) upward displacement of the pelvic ileal loops and extension of the effusion into the flank stripes (large effusion). Perivesical effusions most frequently accompany anterior pelvic arch injuries, i.e., double vertical and Malgaigne fractures and fractures involving, or separation of, the pubic symphysis.

Sonography of traumatic rupture of the bladder: "bladder within a bladder" appearance of extraperitoneal extravasation.

“…Plain radiography may demonstrate, in addition to bone fractures, the characteristic "pear shape" appearance of the bladder, loss of definition of the obturator fat planes, paralytic ileus, and upward displacement of ileal loops. 7 Retrograde cystography may provide direct visualization of the site of e.xtravasion of con trast. 11 Excretory urography should be perfonned, if the clinical condition of the patient allows, in order to rule out an associated upper urinary tract injury.…”