画像は省略したが，肝臓や脾臓の実質臓器，または腸間膜損傷はない．上段のCTで，腹水（※）があり，膀胱に血腫（↑）が充満している．図２で腎損傷を否定できるので，膀胱損傷を疑う．下段の15分後のCTで膀胱内の造影剤の量が増えてはいるが，造影剤の膀胱外漏出所見はない．しかし，次の20分後のCTで腹腔内膀胱破裂の診断がつく．

下段の20分後のCTでは腹腔内に，膀胱内造影剤と濃度が一致する尿の漏出（urinary extravasation：△）を認め，膀胱破裂の診断がついた．手術で血性腹水と膀胱底部に縦方向の4cm長の破裂を認め修復した．

参考症例（腹腔外膀胱破裂）：道路を横断中に乗用車にはねられた54歳女性．下腹部痛と血尿があり搬送された．Vital signsは安定，下腹部に腹膜刺激症状を認めた．
▲が膀胱で，それ以外の造影剤（↑）は膀胱周囲（Retzius腔）に漏出した尿であり，腹腔外膀胱破裂である．膀胱造影で同所見が確認された（図A：△）．腹膜刺激症状があるので手術となったが，保存的治療が可能である．膀胱前壁に5cm長の縦方向の破裂を認め修復した．

文献考察：膀胱破裂の診断にCT膀胱造影が極めて有用
１）AJR Am J Roentgenol. 2006 Nov;187(5):1296-302.
CT cystography with multiplanar reformation for suspected bladder rupture: experience in 234 cases.
Chan DP, Abujudeh HH, Cushing GL Jr, Novelline RA.

OBJECTIVE: CT cystography has replaced conventional cystography in the evaluation of patients with suspected bladder rupture in most trauma centers. We performed this retrospective review to determine the accuracy of CT cystography and the role of multiplanar reformation in the diagnosis of bladder injury. MATERIALS AND METHODS: The patient cohort was composed of trauma patients with clinically or CT-suspected bladder ruptures who were evaluated with CT cystography using two different MDCT scanners at our level 1 trauma center. The patients were identified through Folio, a radiology research tool software system. The CT cystography results were compared with the findings at surgery, clinical follow-up, or both. RESULTS: Between January 1, 2000, and December 31, 2004, 234 patients were examined in our level 1 trauma center with CT cystography. From the total of 234 examinations, 216 (92.3%) were interpreted as negative and 18 examinations (7.7%) were interpreted as positive. On the 18 positive examinations, 11 were extraperitoneal bladder rupture, five were intraperitoneal bladder rupture, and two were combined intraperitoneal and extraperitoneal bladder rupture. Surgical bladder exploration and repair were performed in nine of the 18 cases. Seven (77.8%) of the nine cases had operative findings consistent with the CT cystogram findings. The overall sensitivity and specificity of CT cystography in diagnosing bladder rupture were each 100%. For extraperitoneal bladder rupture, the sensitivity and specificity were 92.8% and 100%, respectively. For intraperitoneal rupture, the sensitivity and specificity were 100% and 99%, respectively. CONCLUSION: CT cystography is accurate for diagnosing bladder rupture. Sagittal and coronal multiplanar reformations may be helpful in identifying most sites of bladder rupture.PMID: 17056919（full text）
要旨：Foleyカテーテルから，60％の造影剤40mlを1000mlの生食に注入し，1.5mの高さから点滴で膀胱内に300〜400mlを注入しCT検査を行う．

２）AJR Am J Roentgenol. 2000 Jan;174(1):89-95.
CT cystography: radiographic and clinical predictors of bladder rupture.
Morgan DE, Nallamala LK, Kenney PJ, Mayo MS, Rue LW 3rd.

OBJECTIVE: Our goal was to identify radiographic and clinical variables that correlate with bladder rupture that may then be used as selection criteria for CT cystography in trauma patients. SUBJECTS AND METHODS: Hemodynamically stable trauma patients with hematuria were examined under standardized protocol with dynamic oral and i.v. contrast-enhanced CT of the abdomen and pelvis, followed immediately by CT cystography. CT cystography consisted of contiguous 5-mm axial scans of the pelvis after retrograde distention of bladder with 300-400 ml of 4% iodinated contrast material. Radiographic and clinical variables (pelvic fracture, pelvic fluid, intraabdominal visceral injury, degree of hematuria, hematocrit, units of blood transfused, base deficit, injury mechanism, seat belt use, sex, age) were assessed and statistically analyzed using the two-tailed Fisher's exact test and Wilcoxon's rank sum test. Positive and negative individual and multivariate predictors were analyzed. RESULTS: Of the 157 patients entered in our study, 12 (eight males and four females) had bladder rupture. One or more pelvic fractures were present in nine (75%) of the 12 patients (p 要旨：Foleyカテーテルから4％に希釈した造影剤300〜400mlを100cmの高さから点滴で落とし膀胱内に注入する．