Cystogram

A trauma cystogram is indicated when we must rule out a bladder injury following a trans-pelvic gunshot wound or an anterior pelvic fracture.

It is best done in the trauma x-ray suite but can be done using the portable machine if necessary.  If there is concern for a urethral injury, that MUST be ruled out first using a urethrogram.

• Wear a lead apron
• Instill contrast into bladder via foley until it stops flowing by gravity
• Inject an additional 50 ml so the contrast is under pressure, then clamp the foley
• Take an AP pelvic film 
• Let contrast flow out of bladder
• Take another pelvic film (post-void)

Only two films are necessary, although some people like to see obliques or lateral views.  The most important films are the "full" and the "empty" (post-void) views.

The "full" view will show you active extravasation
The post-void view will show smaller amounts of extravasation that may be masked by the full bladder.