Spontaneous extraperitoneal rupture of the urinary bladder in children

The authors describe two children who had spontaneous extraperitoneal rupture of the urinary bladder into the retropubic space secondary to acute urinary retention following lower urinary tract surgery. One also had urinary ascites. In one, the urinoma was initially mistaken for the bladder during ultrasonography. In both cases, the diagnosis of bladder rupture was not considered initially because of a lack of familiarity with the occurrence of this entity in children.     

Tödliche Harnblasenruptur bei Blasentamponade nach transurethraler Resektion der Prostata

We report the case of a 74-year-old man with a non-traumatic intraperitoneal rupture of the urinary bladder. On the eighth postoperative day following transurethral resection of the prostate (TUR-P), the patient developed massive, diffuse parenchymal bleeding from arterial vessels in the prostate base. After urinary bladder tamponade with consecutive rupture of the bladder, peritonitis and sepsis occurred with fatal outcome. A traumatic origin of the bladder rupture during TUR-P was excluded by means of the inconspicuous course following the intervention and due to the fact that postoperative contrast radiography of the bladder and resection site showed no leakage of radiopaque fluid. Underlying diseases predisposing to spontaneous bladder rupture such as cystitis, tumour, diverticulum or radiation disease could be excluded by histology. To the best of our knowledge, spontaneous rupture of the urinary bladder following bladder tamponade has not been reported. The occurrence of bladder tamponade following late bleeding complications after TUR-P has also not been described previously.     

肝癌破裂出血的螺旋CT诊断

目的　探讨肝癌自发破裂伴腹腔内出血 (血腹 )的CT诊断。方法　回顾分析 2 2例肝癌自发破裂CT表现 ;分析肝癌破裂出血的机制 ;各种CT病理特征及其与肝癌破裂的关系。结果　所有破裂的肿瘤均位于肝脏的周边带 ,12例显示了突出于肝边界外的实质。肿瘤的最大径为 2～ 16cm ,中心坏死 16例。肝表面不连续 16例。 3例“未发现破裂”的肝癌在增强时发现造影剂外溢至肝边界之外。 2例只显示为肿块中出血但手术中发现已发生了破裂。 1例整个肝脏破裂 ,分离的碎块漂浮于大量的腹水中。 5例增强扫描显示了周边带状强化但不连续低密度病灶。结论　CT诊断肝癌自发破裂有很高的精确度 ,对临床怀疑肝癌自发破裂造成血性腹水者 ,CT检查十分必要。     

Delayed spontaneous rupture of augmented bladder in children: diagnosis with sonography and CT.

With the increasing use of augmentation enterocystoplasty to treat patients with small-capacity, noncompliant bladders, an increase in the number of cases of delayed spontaneous intraperitoneal rupture of the augmented bladder has been reported. Although patients with a ruptured bladder usually will have an acute abdomen, these clinical signs and symptoms may be masked in spina bifida patients because of their neurologic deficit. Cystography and sonography were performed in four spina bifida patients with delayed spontaneous rupture of an augmented bladder. One patient also had isotope cystography. Two patients were examined with CT. Cystographic findings were abnormal in only one case. Peritoneal fluid was identified sonographically in all four cases and also was seen in both CT studies. Our study reveals that enhanced cystography will frequently fail to show leakage from an augmented bladder. Sonography and CT are reliable in detecting free intraperitoneal fluid, a finding that can significantly aid in the diagnosis of ruptured bladder after enterocystoplasty. Therefore, cystography with normal findings must be followed by sonography or CT in order to detect extravasated urine.     

外伤性膀胱破裂37例报告

目的 探讨外伤性膀胱破裂的诊断和治疗方法。方法 本组外伤性膀胱破裂37例中，24例注水试验阳性21例，膀胱造影阳性11例。6例合并尿道损伤，术前未能明确诊断。本组除1例非手术治疗外，其余36例均行膀胱修补、膀胱造瘘或留置导尿管引流术。结果 34例痊愈，3例尿道狭窄，1例性功能障碍，1例轻度尿失禁，死亡3例。结论 膀胱注水试验以及膀胱造影对诊断外伤性膀胱破裂准确性高，但膀胱破裂合并尿道断理解术前一般不易确诊。     

Spontaneous rupture of bladder diverticulum after postoperative radiotherapy for carcinoma of the uterine cervix: a case report

We present a case of spontaneous rupture of bladder diverticulum three years after postoperative whole pelvic irradiation (50.4 Gy) for carcinoma of the uterine cervix. The patient had suffered from a neurogenic bladder after hysterectomy, but excretory urography revealed no abnormalities. Bladder diverticulum was found two years later. Spontaneous rupture of the urinary bladder is one of the late complications associated with radiotherapy, although it is very rare. Postoperative neurogenic bladder may also be associated with rupture. We should be aware of this rare complication in patients who receive pelvic irradiation.     

Detection of pancreatic fluid and urine leakage after pancreas transplantation: value of CT and cystography

Leakage from the urinary bladder or duodenal stump after pancreas transplantation with urinary bladder drainage of the graft is difficult to diagnose clinically. We retrospectively reviewed our experience with fluoroscopic cystography and CT to determine their relative merit in the diagnosis of pancreatic fluid and urine leakage as documented by surgical exploration in pancreas transplant recipients. Thirteen leaks were diagnosed by fluoroscopic cystography or by CT in 11 patients after pancreas transplantation with urinary bladder drainage of pancreatic fluid. Conventional retrograde fluoroscopic cystography showed 11 leaks; CT with retrograde bladder opacification showed three leaks. Of the five CT studies that did not show a leak and that also were done within 7 days of a cystogram with abnormal findings, failure to use retrograde bladder opacification accounted for the majority (three cases) of missed diagnoses. Focal or free peritoneal abdominal fluid was seen in all CT examinations, with extravasation of contrast material seen into both walled-off collections and free ascites. Our experience suggests that retrograde bladder and duodenal stump opacification should be a routine part of the CT evaluation performed to detect leakage from the urinary bladder or duodenal stump after pancreas transplantation.     

原发性肝癌自发破裂的CT评价

目的：探讨并提高对肝癌自发破裂伴腹腔内出血（血腹）的CT诊断,方法：回顾分析8例经手术证实的肝癌自发破裂临床的影像资料。分析各种病理情况的影像特征及其与肝癌破裂的关系。包括肝硬化表现,腹水,肿瘤在肝内位置,肿瘤凸出肝外程度和中心坏死情况,结果：8例患者CT扫描发现12个癌灶,其中1例CT仅见血腹而未见肝癌病灶,手术探察发现肝边缘小肝癌破裂,继发肝包膜下和腹腔积血,CT诊断肝边小肝癌的精确性达85％,结论：CT诊断肝癌自发破裂有很高的精确度,对临床怀疑肝癌自发破裂造成血腹者,CT检查十分必要。     

The value of CT in the detection of bladder and posterior urethral injuries

To determine the value of CT in the diagnosis of bladder and posterior urethral injuries, we retrospectively evaluated the CT and urethrocystographic findings in 33 trauma patients with suspected injuries of the lower urinary tract who had both studies in their initial evaluation. In 26 (79%) of 33 patients, results of both examinations were normal. Seven (21%) of 33 patients had bladder injuries (seven--two in one patient) and/or posterior urethral injuries (three) as determined on the basis of urethrocystography. Three patients had extraperitoneal bladder tears as the only injury to the lower urinary tract. Two patients had both extraperitoneal bladder tears and posterior urethral injuries. One patient had both an extraperitoneal tear at the bladder base and an intraperitoneal rupture at the bladder dome. The seventh patient had an isolated posterior urethral injury. All seven bladder injuries were detected with CT. In these cases, CT findings included (1) free intraperitoneal contrast material (one case), (2) focal contrast extravasation (three cases), and (3) paravesical fluid collections that on delayed CT scans revealed contrast accumulation in the fluid, indicating extravasation (two cases). The seventh bladder injury was suspected on CT and confirmed with retrograde urethrography. Only one of three posterior urethral injuries was detected with CT. Our results suggest that CT is sensitive in the detection of bladder injuries, but not for the diagnosis of urethral injuries.     

Direct invasion of urinary bladder from sigmoid colon cancer: CT findings.

Radiological findings in three cases of sigmoid colon carcinoma invading the urinary bladder are reported. An irregular spiculated margin or nodular indentations in region of bladder dome were seen on intravenous urography. A soft tissue mass contiguous with an irregularly thickened urinary bladder wall and a circumferentially thickened sigmoid colon wall were demonstrated on CT and sonography and led to the correct diagnosis.     

Bladder injury in blunt pelvic trauma

Clinical and radiologic findings in 97 patients with bladder injury secondary to blunt pelvic trauma were reviewed. Fifty-five patients had extraperitoneal bladder rupture; 35, intraperitoneal rupture; two, interstitial bladder injury; and five, combined intraperitoneal and extraperitoneal bladder rupture. Of the 61 of 97 patients with film studies available for review, two patients with surgically proved intraperitoneal rupture had false-negative cystograms. In two other cases of intraperitoneal rupture, the diagnosis was established with cystography but was not demonstrated with urography. All cases of extraperitoneal rupture were demonstrated cystographically; in 15 cases in this group, the injury was complex, with extravasation of contrast material beyond the confines of the perivesical space. In two additional patients, incomplete bladder injury termed "interstitial bladder rupture" was identified. A classification of bladder injury based on cystographic patterns of extravasation is proposed.     

膀胱癌的MRI诊断及分期

目的；探讨ＭＲＩ在膀胱癌的术前诊断及分期的应用价值。材料与方法：搜集２０例采用０．５Ｔ磁共振扫描检查，经手术病理证实的膀胱癌，分析其ＭＲＩ表现。结果：根据肿瘤的ＭＲＩ表现将其分为腔内型，浸润型和腔外型。术前ＭＲＩ诊断与ＴＮＭ分期符合率为８０％（１６／２０），ＭＲＩ较病理分期偏高。结论：Ｔ１加权像主要用于肿瘤的定性诊断，Ｔ２加权像主要用于肿瘤的术前分期：ＭＲＩ与病理分期有较高的符合性。     

Ascites during the first week of life (author's transl)]

Retrospective analysis of 22 cases with neonatal ascites showed the most common cause to be anomalies of the urogenital system (urethral valve, hydronephrosis, rupture of bladder, rupture of ovarian cyst). Next came malformations of the gastro-intestinal tract and of the liver and congenital infections (toxoplasmosis, cytomegaly). In 4 cases the cause was not found. More than one half of the cases permitted a definitive radiologic diagnosis, mainly in malformations requiring surgery. We suggest a standardized procedure of investigation of all cases with neonatal ascites. If this procedure does not result in a positive diagnosis and if the ascites fluid does not contain blood or bile, we fell that laparotomy is not indicated.     

急性尿潴留的超声分型及其临床意义

目的探讨急性尿潴留的超声分型及其临床意义。方法回顾性分析了57例急性尿潴留患者声像图表现。结果 (1)急性尿潴留声像图表现的共同点为膀胱过度充盈,随程度的不同有输尿管扩张,肾积水、肾周积液等继发声像图表现。(2)根据急性尿潴留的继发声像图不同可分为单纯膀胱型,肾型,肾周型三大类。结论超声对急性尿潴留的观察不能只单纯关注膀胱本身,还要逆行向上探测肾以及肾周的相关情况,从而为临床明确病情临床选择合适的治疗方式提供帮助。     

Expanding experience with spontaneous dermoid rupture in the MRI era: diagnosis and follow-up

With widespread use of CT and MR imaging, experience with spontaneous dermoid rupture has significantly increased. What was previously believed to be a generally severe or even fatal accident, being the diagnosis made either at surgery or autopsy, or in patients with such consequent conditions as chemical meningitis or obstructive hydrocephalus, now appears to be more frequent than previously thought, and there is some evidence that it may also cause only a slight symptomatology or even be quite asymptomatic. We reviewed the clinical and imaging data of our series of five patients with spontaneously ruptured dermoids, spinal in one case, and intracranial supratentorial in four. These had their diagnosis following mild symptoms (number two cases) or incidentally (number two cases); the spinal tumor caused acute bladder dysfunction, possibly while undergoing rupture, and was associated with indolent intracranial fat spread. Three of the patients also had MR demonstration of asymptomatic persistence of fat spread in the subarachnoid spaces, respectively, 3, 4, and 5 years after rupture. One of the five cases, concerning a parasellar dermoid followed up over 6 years, provides the first demonstration of MR signal intensity change of the tumor prior to rupture.     

多层螺旋CT曲面重建在诊断泌尿系结核的价值

目的:探讨多层螺旋CT(multislice spiral CT,MSCT)曲面重建(curved planar reconstruction,CPR)在诊断泌尿系结核中的价值.材料和方法:收集经病理检查证实的23例泌尿系结核,分析其征像,比较三维后处理技术的结果,并评估其在诊断泌尿系结核中的应用价值.结果:双肾、输尿管同时受累9例,其中4例同时累及膀胱;单侧肾及输尿管受累13例,同时累及膀胱1例;仅发生于单侧输尿管下段1例.MSCT表现为患肾实质内多个大小不一的囊样低密度影,边缘模糊,增强扫描边缘轻度增强,排泄期见造影剂充填,输尿管管壁不均匀增厚、管腔变窄,其间见扩张的输尿管,增强明显,呈串珠状改变,肾功能不同程度受损;膀胱受累表现为膀胱腔明显缩小,壁增厚,增强明显;大范围的曲面重建可全程清晰显示病变累及范围,直观显示输尿管腔内外改变,与术中及病理符合.结论:MSCT能清晰地显示病变部位、累及范围、腔内外改变以及肾功能情况,是诊断泌尿系结核的一种很好的影像方法,CPR对病变的显示及诊断非常实用.     

多层螺旋CT扫描及三维重建在诊断膀胱副神经节瘤中的应用价值

目的：探讨多层螺旋CT扫描及三维重建在诊断膀胱副神经节瘤中的应用价值。方法回顾性分析我院2010年7月-2014年1月经术后病理证实的5例膀胱副神经节瘤患者的CT资料。5例患者均进行多层螺旋CT扫描以及三维重建,并分析膀胱副神经节瘤的CT特点。结果5例患者均为单一病灶,2例呈不均匀明显强化,1例呈中度强化,另2例呈轻度强化;1例发现盆腔肿大淋巴结1枚,直径约1．7cm。CT扫描发现的病变数量、位置、大小、特征及周围淋巴结出现转移与术中所见及术后病理结果一致。结论多层螺旋CT扫描及三维重建在膀胱副神经节瘤的诊断中有重要价值,可为临床诊断及手术计划的制定提供较为准确的依据。     

Unexpected death due to spontaneous splenic rupture: A rare case in splenic angiosarcoma

Splenic angiosarcoma (SA) is a rare disease that can cause spontaneous splenic rupture leading to unexpected death. The rare incidence and non-specific clinical presentations made the early correct diagnosis of SA impossible in clinical practice. Even with medical intervention, 80% of patients died within 6 months after diagnosis. Here, we report a man who had complained of abdominal distension for 2 weeks and succumbed to the disease nine hours after admission. Diagnosis of hepatic and splenic angiosarcomas was based on post-mortem histopathological examination and immunohistochemistry, and the cause of death was hemorrhagic shock caused by spontaneous splenic rupture secondary to SA. This present case was the first forensic autopsy of spontaneous splenic rupture secondary to SA, which can highlight the diagnosis of rare diseases in forensic practice, and forensic pathologists should bear in mind these rare diseases even in routine practice.     

膀胱癌的CT分期与病理对照

目的 分析膀胱癌的CT表现，并与手术病理对照，提高膀胱癌的术前分期诊断水平。方法分析13例膀胱癌的CT表现及术前分期，并与手术病理结果对照。结果膀胱癌主要表现为膀胱壁局限性或弥漫性增厚，形成菜花样肿物向腔内突出，可向壁外生长侵犯盆腔组织器官及淋巴结转移，膀胱周围脂肪间隙模糊。膀胱癌的术前CT分期正确率为69．3％。结论螺旋CT扫描能显示膀胱癌的CT特征及向膀胱壁内、外生长情况，对术前分期有意义。     

原发性肝癌自发性破裂出血临床特点及影像学诊断

目的 探讨原发性肝癌（ＨＣＣ）自发性破裂出血的临床特点及影像学表现。材料与方法 根据９例ＨＣＣ自发性破裂继发腹腔内出血临床表现,结合超声,ＣＴ,血管造影征象进行分析。结果 ＨＣＣ自发性破裂出血临床主要表现为急性上腹部疼痛,腹腔内出血,失血性休克。超声检查主要显示ＨＣＣ出血部位出现高回声区。ＣＴ扫描显示ＨＣＣ出血区出现高密度影,腹腔内出血表现为腹腔积液ＣＴ增高。血管造影显示肿瘤血管破裂区出现对比剂外