E4615. Ready to Burst: Fluoroscopic Cystogram Technique and Case-Based Imaging Review
  1. Alexander Antigua Made; Burnett School of Medicine at Texas Christian University
  2. Prahasit Thirkateh; Northwestern University
  3. Linda Kelahan; Northwestern University
Fluoroscopic cystogram (FC) is a dynamic imaging technique that aids in the evaluation of both normal and abnormal bladder findings. FC is commonly used for assessing bladder rupture or leak. While other modalities like CT cystography can be utilized to investigate bladder trauma, it is important to highlight that FC demonstrates equal effectiveness to CT cystography in detecting the presence or absence of bladder injury. Furthermore, when compared to alternative imaging methods, FC offers the advantage of being more cost-effective and results in low radiation exposure for the patient. FC serves as a versatile diagnostic tool with applications beyond bladder injury cases. It is also utilized for assessing vesicoureteral reflux, defining anatomical structures, and measuring post-void residual volume.

Educational Goals / Teaching Points
One of the goals of this educational exhibit is to detail and show examples of proper FC technique. This includes essential steps such as acquiring scout images in various projections, capturing both early filling and full distention images, and performing post-void imaging. Furthermore, we will discuss procedural techniques like Foley catheter placement, patient positioning, contrast administration, radiation-reduction techniques, and troubleshooting tips. We intend to review the common indications for FC, expected findings of a normal FC, and importantly, certain normal observations during cystography that can be mistaken for abnormal conditions, such as prostatic duct or seminal vesicle reflux.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will illustrate multiple diagnoses through a case-based format with FC images, as well as CT and MRI correlation when relevant. Specifically, we will show cases of postoperative outcomes following procedures such as cystostomy repair, psoas hitch, ureteral reimplantation, simple and radical prostatectomy, and cystectomy with ileal conduit (loopograms); posttraumatic bladder leak; colovesical, enterovesical, and vesicovaginal fistulas; bladder wall trabeculation and bladder diverticula; urinary retention; and vesicoureteral reflux.

In conclusion, we will elaborate on anatomical reference points and distinctive observations that facilitate the recognition of both typical and atypical cystogram findings. Each case presented will include a key learning point relevant to FC. Through this case-based approach, our aim is to highlight the practical versatility and dynamic utility of FC in the investigation of diverse aspects of bladder pathology.