Ann Rehabil Med.  2017 Apr;41(2):323-327. 10.5535/arm.2017.41.2.323.

Extravasation of the Contrast Material During Voiding Cystourethrography in a Chronic Spinal Cord Injury Patient: A Case Report

• Kwon S
• Park D
• Lee HH
• Ryu JS

• KMID: 2389493
• DOI: http://doi.org/10.5535/arm.2017.41.2.323

Abstract

Neurogenic bladder is common in most spinal cord injury patients. Voiding cystourethrography (VCUG) is recommended in these patients to detect urinary tract complications. However, rare but serious complications may occur during VCUG, although VCUG is generally safe. There are several case reports of bladder rupture occurring in pediatric patients. Here, we report the first case of iatrogenic bladder rupture in an adult spinal cord injury patient in Korea. Particularly, extravasation of contrast without manual instillation has hardly ever been reported. To the best of our knowledge, this is the first reported case of bladder rupture without manual instillation during VCUG. We report a case of a 59-year-old female with paraplegia due to tuberculous spondylitis who underwent VCUG as a part of routine evaluation of neurogenic bladder. Extravasation of the contrast media during VCUG developed as a complication and the patient recovered spontaneously without any intervention. Therefore, VCUG should be performed properly in chronic spinal cord injury patients.

Keyword

Urinary bladder; Neurogenic; Spinal cord injuries; Cystography

MeSH Terms

Adult
Contrast Media
Female
Humans
Korea
Middle Aged
Paraplegia
Rupture
Spinal Cord Injuries*
Spinal Cord*
Spondylitis
Urinary Bladder
Urinary Bladder, Neurogenic
Urinary Tract
Contrast Media

Figure

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  Fig. 1 Magnetic resonance imaging (MRI) images showing T3 vertebral body collapse and wedge-shaped deformity in coronal (A) and central canal stenosis with spinal cord atrophy at the T3 level in axial MRI (B).

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  Fig. 2 Urodynamic study reveals vesical pressure rising during 127 mL of contrast infusion (blue arrow) and the bladder capacity was 231 mL at 54 cmH2O (red arrow).

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  Fig. 3 Initial voiding cystourethrography showing extraperitoneal contrast material (short arrows) on anteroposterior view (A), right oblique view (B), and left oblique view (C).

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  Fig. 4 (A) Coronal and (B) axial computed tomography (CT) images of the abdomen. CT imaging showing contrast leak into the perivesical and paravesical spaces (arrow).

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  Fig. 5 Voiding cystourethrography performed 2 weeks after bladder rupture shows no leakage of contrast material.

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