 Good evening all, myself Dr. Parthav Verma, finally a radiology resident from Osmania Medical College. First, I'd like to thank CTBus for this opportunity. Today, I'm gonna present CTCistography evaluation of urinary bladder trauma. Introduction, urinary bladder injury may result from either blunt or penetrating trauma. The propensity for bladder injury is related to degree of bladder distention at the time of impact. Associated injuries may lead to mortality rate as high as 44%. Bladder injuries may be extra-peritone and intraperitone are combined. Traditional bladder injuries often have been evaluated with the dedicated conventional cystography. CTCistography has replaced the conventional cystography as it allows multi-panel reconstructions to identify the site of rupture differentiating between intraperitonella and the extra-peritoneal rupture and a complete study of abdominal pelvic region in patients with abdominal trauma. Aims and objectives of my study are to identify anatomical spaces related to bladder and to describe the imaging features of bladder injury in CTCistography. Materials and methods, all patients with suspicion of bladder trauma presented to Usmane General Hospital, CTCistography was done in Hitachi 128 slice CT. Suspicion of bladder trauma, such as conventional CT findings of pelvic fractures, hematuria after trauma, mechanism of trauma that leads to a high suspicious of bladder trauma, they were referred to CTCistography. Technique is preliminary CT pelvis for fractures and then preparation of final ML of diluted contrast solution, installation of 350 to 400 ml of contrast solution under gravity through the police catheter, clamp the catheter to maintain adequate bladder distention, then post-contrast CT pelvis. Observation on results, these pie chart showing distribution of pieces with suspected bladder injury, in that on CTCistography of 18 patients, seven patients had bladder injury and 11 patients had no bladder injury. This is a gender-wise distribution of bladder trauma cases in which out of seven cases, five are males, two are females. Type of bladder trauma, five are intraperitoneal bladder trauma and two are extroperitone. Come to the anatomy. Here is a image showing normal male pelvis and female pelvis. The spaces are related to urinary bladder loss, pre-vesical space that surrounds and contain urinary bladder, recto-vesical space and then intraperitoneal space between urinary bladder and rectum, pre-zacral space, pre-vesical space or space of ridges, is an intra-extroperitoneal space located posterior to the pubic synthesis and anterior to the urinary bladder and recto-uterine pouch or pouch on dog loss. This is extension of peritoneum between the rectum and posterior wall of the uterus. This is analogous to recto-vesical post-skin males. And then come to the cases. Okay, so one is a complex extroperitoneal rupture. Image one and two are the axial images of CT-C histogram showing three E-extravagated contrast noted in false facial planes of bladder with the tracking of contrast noted along the anterior abdominal wall, bilateral inguinal canal, antromedial aspect of left thigh gluteal region, syndicate complex extroperitoneal rupture of the bladder. Case two, extroperitoneal rupture of bladder. Figure three, axial images of CT-systrography showing contrast extravagation in retro-pubic region, syndicate extroperitoneal bladder rupture. If image four is axial section with bone window showing cracker left inferior pubic ramus. Case three, axial and coronal CT images of showing extravagated contrast material outlines of bowel loops and perihepatic region in the intrapuritoneal cavity, suggest of intrapuritoneal bladder rupture. Case four, CT-C histogram demonstrate classical appearance of an intrapuritoneal rupture which is extravagated contrast material between the bowel loops and in the subhepatic region as shown by the arrows and the case five. The coronal image of CT-systrography showing extravagated contrast material between the bowel loops of peritoneum in pelvis, suggest of intrapuritoneal rupture. Until the discussion, radiologist should be familiar with unabokal spaces and structures in order to make a good approach to bladder injuries. Spaces surrounding bladder are pre-vesecal space, recto-vesecal pouch, recto uterine space and pre-sacral pre-vesecal spaces. CT-systrography have been advocated in lieu of conventional systrography in initial workup of patients with suspected bladder trauma. CT-systrography was applied to classification scheme for bladder injury based on degree of wall injury and unabokal location and demonstrated characteristic imaging features for each type of injury. Bladder injury can be classified into contusion, interstitial injury and rupture. Abert et al stated that 60 to 90% of patients with bladder injuries caused by blunt trauma have associated with pelvic fractures and 44% of patients with bladder injuries have at least one or other intra-abdominal injury. In current study, most common associated injury with bladder trauma was pelvic fractures. The most commonly observed type of pelvic fracture in our study are unilateral pubic ramia fractures and fractures of pubic bones. Conditional systrography has long been considered as a standard reference for evaluating patients with suspected bladder injury as increased diagnostic accuracy and characterization of injuries on CT-systrography. It is replaced with radiography in many trauma centers. Coming to types of bladder trauma, type one is bladder contusion, which is a inclumpillate or partial tear of bladder miposa. CT findings usually normal. Type two is intrapytonal rupture. CT-systrography demonstrates intrapytonal contrast material around the bubble loops and between the concentric folds and in the paracolic gutters. Type three is interstitial bladder injury, which manifestations include intramural hemorrhage, submucosal extravasation of contrast material without transmural extension. Type four is extrapytonal rupture, which is further classified into simple and complex, simple includes extravasated contrast material is limited to peri vesicle spaces. Complex is contrast solution extends further into abdominal wall, perineum, scrotum and dissect the facial planes and spaces. Type five is combined intra and extrapytonal rupture, usually demonstrate extravasation patterns that are typical for both types of injury. It's a classification system for bladder injury based on findings on CT's historiography. As we discussed, type one is bladder contusion, two is intrapytonal rupture, three is interstitial bladder injury, four is extrapytonal rupture, four and then four A is simple extrapytonal, four B is complex extrapytonal rupture, five is combined type of bladder injury. Come to the conclusion, CT's historiography provide experience evaluation of urinary bladder injuries with high degree of sensitivity and specificity. Urinary bladder injuries have characteristic CT's historiography features that can be used for accurate classification and better treatment planning. The CT's historiography does not only aid the diagnosis of urinary bladder injuries, but also device role in surgical procedures. In patients with suspected bladder injury due to trauma, CT's historiography should be done even if the initial findings of non-contact CT are negative. These are my references. Thank you. I would like to thank my HOD, my professors.