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  #1  
Old 04-19-2010
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Surgery Pelvic Fracture + Bloody Urine

A 24-year-old woman sustains multiple injuries in a car accident, including a pelvic fracture. She is hemodynamically stable. Initial assessment shows no vaginal or rectal injuries; however, when a Foley catheter is inserted, bloody urine is recovered. Which of the following would be the best way to evaluate her urologic injury?
A. Sonogram of the bladder
B. Intravenous pyelogram
C. Cystoscopy
D. Retrograde cystogram including post-void films
E. Retrograde cystogram including views of the ureters

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Old 04-19-2010
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Arrow the answer is D

the answer is D: retrograde cystogram with postvoid films.

its a Bladder injury... Usually associated with pelvic fractures....
the xray must include postvoid films to see extraperitoneal leaks at the base of the bladder that might be obstructed by the bladder full of dye.
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Old 04-19-2010
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Oh yes, it's D for sure
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Old 11-13-2011
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What is the difference between answer D & E, any body if you like!!
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Old 11-13-2011
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This is an old question (before 2008)

Now for hematuria + Pelvis FX should be CT cystogram.

Campbell-Walsh Urology, 10th. ed. (August 25, 2011)

Pelvic Fracture + Bloody Urine-urology.jpg

For more info:
http://emedicine.medscape.com/article/377735-overview

"Retrograde cystography, performed after urethrography, was considered the criterion standard for evaluation of bladder trauma. However, support has grown for using CT cystography in proper diagnosis. Initial studies were not indicative of the reliability of CT scanning when retrograde contrast enhancement was not used. However, contemporary studies have overwhelmingly demonstrated that the technique is sensitive and accurate, provided that adequate bladder distention (with at least 350-400 mL of contrast material) is achieved before the study is performed. In diagnosing bladder rupture, CT cystography, performed with 400 mL of contrast material that is administered in a retrograde fashion, is as accurate as plain radiography with retrograde cystography"
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