RADIOLOGY: GENITOURINARY: GU: Case# 32938: EXTRAPERITONEAL BLADDER RUPTURE. 36 year old male involved in a MVA. Within the pelvis, there are several fractures including intra articular symphysis pubis fracture on the right with minimally displaced fractures of the right superior and inferior pubic rami. There is a large amount of contrast within the left pelvis adjacent to the bladder consistent with an extraperitoneal bladder rupture. Small amount of free air is also present surrounding the bladder which is thought to be related to this bladder rupture. Bladder rupture occurs in 10% of patients with pelvic fractures usually due to lacerations by bone fragments resulting in leakage of urine and contrast into the extraperitoneal space. Intraperitoneal rupture is usually the result of blows to the lower abdomen while the bladder is distended. Both types of rupture are readily demonstrated by CT following contrast administered intravenously or by bladder catheter. With intraperitoneal ruptures, contrast is seen within the peritoneal cavity surrounding bowel loops and extending into the pericolic gutters. Extraperitoneal rupture results in leakage of urine and contrast into the retropubic space and extending along fascial planes to the abdominal wall, into the retroperitoneal compartments, and into the scrotum and thigh.