CT Abdomen and Pelvis For blunt trauma, CT of the abdomen and pelvis with IV contrast is recommended, in the portal venous phase, 70 seconds after contrast administration for ideal characterization of solid organ injury, including the genitourinary system. This may be obtained in conjunction with CTA if there is a concern for renal infarction or arterial injury, as well as delayed imaging of the abdomen and pelvis if perinephric fluid suggests renal pelvis or ureteral trauma. The administration of oral contrast material has not been found to alter the sensitivity or specificity for blunt abdominal injuries and is not recommended because it can delay definitive diagnosis of other injuries [25]. Noncontrast CT of the abdomen and pelvis should ideally be avoided if there is no contraindication to IV contrast because of its lower sensitivity for detecting both visceral organ and vascular injuries [19]. CT Urography There is no relevant literature to support the use of CTU in the initial evaluation of patients who are hemodynamically stable with suspected urinary system or urethral trauma. CT Pelvis with Bladder Contrast (CT Cystography) Gross hematuria in the setting of blunt traumatic injury necessitates further evaluation with CT cystogram [30]. Urinary bladder injury typically occurs because of trauma to a distended urinary bladder and may or may not be accompanied by pelvic fractures. The absence of gross hematuria generally excludes the possibility of urinary bladder injury [31]. Deck et al [32,33] reported sensitivities of 95% overall but only 78% for intraperitoneal rupture. In another study with 100% sensitivity and 99% specificity for intraperitoneal bladder rupture, the specific sites of Major Blunt Trauma dome injuries in 4 of 18 patients were identified only with multiplanar reconstructed images [34]. A bladder contusion may not be visible by CT cystography.
Major Blunt Trauma. CT Abdomen and Pelvis For blunt trauma, CT of the abdomen and pelvis with IV contrast is recommended, in the portal venous phase, 70 seconds after contrast administration for ideal characterization of solid organ injury, including the genitourinary system. This may be obtained in conjunction with CTA if there is a concern for renal infarction or arterial injury, as well as delayed imaging of the abdomen and pelvis if perinephric fluid suggests renal pelvis or ureteral trauma. The administration of oral contrast material has not been found to alter the sensitivity or specificity for blunt abdominal injuries and is not recommended because it can delay definitive diagnosis of other injuries [25]. Noncontrast CT of the abdomen and pelvis should ideally be avoided if there is no contraindication to IV contrast because of its lower sensitivity for detecting both visceral organ and vascular injuries [19]. CT Urography There is no relevant literature to support the use of CTU in the initial evaluation of patients who are hemodynamically stable with suspected urinary system or urethral trauma. CT Pelvis with Bladder Contrast (CT Cystography) Gross hematuria in the setting of blunt traumatic injury necessitates further evaluation with CT cystogram [30]. Urinary bladder injury typically occurs because of trauma to a distended urinary bladder and may or may not be accompanied by pelvic fractures. The absence of gross hematuria generally excludes the possibility of urinary bladder injury [31]. Deck et al [32,33] reported sensitivities of 95% overall but only 78% for intraperitoneal rupture. In another study with 100% sensitivity and 99% specificity for intraperitoneal bladder rupture, the specific sites of Major Blunt Trauma dome injuries in 4 of 18 patients were identified only with multiplanar reconstructed images [34]. A bladder contusion may not be visible by CT cystography.