CincyKidsRad

Cincinnati Children's Radiology

Sagittal CT cystogram shows an extraperitoneal bladder rupture (arrow). Contrast/urine also extends through a defect (dashed arrow) in the anterior abdominal wall.

Extraperitoneal rupture is the most common type of bladder rupture and is usually associated with pelvic fractures or penetrating trauma. Intraperitoneal bladder rupture is usually caused by direct blunt trauma to a full bladder.

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Coronal (image 1) and axial (image 2) images from fetal MRI show an abnormal appearance of the kidneys (arrows) with multiple cortical cysts and massive enlargement of the ureters (arrowheads). On postnatal voiding cystourethrogram (image 3) bladder rupture is visible. Contrast fills the urinary bladder (arrowhead). There is leakage of contrast (arrow) from the right lateral aspect of the bladder and pooling (dashed arrow) within the right lower quadrant. Posterior urethral valves is the most common cause of fetal bladder outlet obstruction. Bladder rupture is an uncommon manifestation of this obstruction. High-grade vesicoureteral reflux is more common and leads to kidney damage. Posterior urethral valves as the most common cause of chronic kidney injury in children.

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Abdominal radiograph shows multiple bladder stones (arrows) and a dislocated right hip. Primary pediatric bladder stones most commonly occur in the setting of urinary stasis related to a neurogenic bladder. Affected pediatric patients usually have cerebral palsy or paralysis making complete emptying of the bladder (even with catheterization) difficult.

Although both benign and malignant bladder lesions could be considered, including rhabdomyosarcoma, the most common pediatric bladder tumor, the calcification in an adjacent bowel loop makes an inflammatory pseudotumor a primary concern. The patient underwent additional CT imaging which shows the fungating bladder lesion (blue arrow) with an adjacent inflammatory process and calcification in the right lower pelvis. At surgery, the mass was confirmed to be an inflammatory pseudotumor from previously ruptured appendicitis with an appendicolith (yellow).

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