title: Should Echogenic Material in the Urinary Bladder Noticed on FAST Preclude Urinary Catheter Insertion in a Trauma Patient Until Further Evaluation?
abstract: BACKGROUND
  Serious urethral and bladder injuries are most often associated with severe blunt trauma. The most common diagnostic tool used to assess lower urinary tract injuries is a retrograde urethrogram. However, the decision to place a Foley catheter is often made on clinical grounds during initial stabilization phase of a trauma victim. If there is a clinical suspicion of a urethral injury, a Foley catheter should not be introduced until further evaluation is made. Focused abdominal sonography for trauma (FAST) is a major tool for primary evaluation of trauma victims. Treating trauma patients, we encountered an unusual "pick up", namely, blood clots in the urinary bladder in two patients.
  
  
  METHODS
  We report on two cases of severely traumatized patients on which FAST examination detected an echogenic material in the bladder. This correlated with severe injuries to the urethra and urinary bladder. Moreover, ignorance of this finding in a patient without obvious clinical signs of urethral injury (Patient 1) led to a Foley catheter insertion, and as a consequence, a complex jatrogenic injury to the urethra. On the basis of this study, we hypothesize that the presence of an echogenic material on FAST examination should be considered blood until proven otherwise, and a urinary bladder catheter should not be passed, even in the absence of clinical signs of urethral injury. Since urogenital trauma is rare, this concept should be validated in the prospective study in a high-volume trauma center.
authors.affiliation: Department of General Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel. aradair@bezeqint.net.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. aradair@bezeqint.net.|Department of General Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva, 49100, Israel. aradair@bezeqint.net.
authors.forename: David
authors.initials: D
authors.lastname: Aranovich
authors.affiliation: Department of General Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Oleg
authors.initials: O
authors.lastname: Kaminsky
authors.affiliation: Department of General Surgery, Meir Hospital, Kfar-Sava, Israel.
authors.forename: Eugeni
authors.initials: E
authors.lastname: Zigerman
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Radiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
authors.forename: Eithan
authors.initials: E
authors.lastname: Yussim
authors.affiliation: Department of General Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Franklin
authors.initials: F
authors.lastname: Greif
keywords: FAST; Ultrasound for urinary tract injuries; Urinary bladder injury; Urogenital injury
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