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Abdominal CT: Cystogram

While a CT urogram is a great way to visualize the upper genitourinary tract, when you want to evaluate just the bladder using imaging, a CT cystogram is your best option... The cystogram does not use IV contrast. Instead, a urinary catheter is inserted and contrast is infused into the bladder using gravity. This continues until there is a sensation of fullness and slight discomfort, which indicates contraction of the bladder muscle. It is important to reach this point because some bladder injuries do not become visible before this contraction.

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 Retrograde cystogram

Gross or microscopic hematuria (>50 RBCs per high-power field) following blunt trauma requires a retrograde cystogram to evaluate for bladder injury. If blood is present at the meatus, however, urethral injury (not discussed) should be suspected and retrograde urethrogram should be performed before passing a Foley catheter. A retrograde cystogram is performed by infusing diluted contrast into the bladder (200-400 mL) to gently distend the bladder and allow visualization of potential rupture(s). A CT scan of the abdomen and pelvis is then performed to determine if any contrast has leaked from the bladder; alternatively an AP pelvis can also be used, but is not as sensitive as CT.

Articles of Interest

CT cystography versus conventional cystography in evaluation of bladder injury

CT cystography is an accurate method for evaluating bladder injury in the blunt abdominal trauma victim with hematuria. CT cystography, performed in conjunction with routine CT of the abdomen and pelvis for evaluating traumatic hematuria, would therefore preclude conventional cystograms in these patients.

Cystogram. A basic skill for radiologists

Cystography refers to a conventional radiographic examination of the urinary bladder with iodinated contrast medium instilled through a urethral catheter. Sometimes the bladder is studied in an anterograde fashion as part of an IV urography.

ED Management of GU & Pelvic Trauma - Dr. Gibbs

Cystogram - lower abdominal pain and gross hematuria or really jacked up pelvis with microscopic hematuria; -How to - Foley catheter in, 400-500 cc contrast, clamp foley, shoot single A film, drain bladder, shoot post-void AP film

Imaging of urinary bladder injury: the role of CT cystography

Although conventional radiographic cystography has been traditionally considered the reference standard in detecting bladder injuries, computed tomography (CT) cystography has become the initial imaging method of choice in the acute setting.

Retrograde CT Cystography Protocol In The Trauma Patient- Volume Matters

The European Society of Emergency Radiology (ESER) guidelines recognize CT Cystogram as the diagnostic test of choice for traumatic bladder injury. However, there is no universal consensus on the exact volume required for appropriate retrograde distension of the bladder. A radiologist’s ability to evaluate and give an accurate interpretation of CT cystogram findings hinges upon a protocol that adequately distends the bladder. While a large, extraperitoneal bladder rupture may be markedly apparent without requiring a significant volume of contrast administration, the more subtle but still clinically significant injuries may go unrecognized if the bladder is underfilled. Our literature search demonstrates that uniform retrograde administration of 300-350cc of diluted water-soluble contrast is required for adequate distension of the bladder and accurate assessment of bladder injury in the trauma patient

Retrograde Urethrography and Cystography

The role of retrograde urethrography and cystography in the trauma patient is to rule out a partial urethral rupture, complete urethral rupture, or a bladder rupture. On initial presentation to the Emergency Department there are clear indications for performing these procedures. The importance of proper training in these techniques must be stressed to avoid iatrogenic or secondary urologic injury.

Voiding Cystourethrogram

A voiding cystourethrogram (VCUG), or cystogram, is a radiology study to evaluate the structure and function of the urinary system. This study uses a small amount of radiation and an x-ray machine to take pictures of the urinary system while the bladder is filled with liquid contrast material. The radiology images are then projected onto a computer screen and evaluated by the radiologist and your childʼs medical provider. There are two types of cystograms: voiding cystourethrogram (VCUG)/fluoroscopic or radionuclide cystogram (RNC). Both tests use have similar preparation and procedure, but use different radiological technique.

What is cystography?

During cystography, the healthcare provider will insert a thin tube called a urinary catheter and inject contrast dye into your bladder. The contrast dye will let the provider see your bladder more clearly. They will take X-rays of the bladder. Cystography is sometimes combined with other procedures. For example, cystourethrography images the bladder and the urethra. The provider may also use fluoroscopy to watch how the bladder empties while you urinate (voiding cystourethrography). Cystography may show whether any urine backs up into the kidneys (vesicoureteral reflux). CT cystography is sometimes used following trauma or recent surgery.

Resources

Radiopaedia

Cystography is a fluoroscopic study that images the bladder. It is similar to a voiding cystourethrogram (VCUG), and the difference between the studies is primarily one of emphasis; a cystogram focuses on the bladder and a VCUG focuses on the posterior urethra. The study has been adapted to CT as a CT cystogram.