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Pelvis » Urinary Bladder
Hematoma in the space of Retzius mimicking the urinary bladder
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Presentation This 68 yo male patient is post laparoscopic surgery for prostate cancer.  The patient was sent to ultrasound with a diagnosis of urinary retention and a request for assessment of the volume of clot in the bladder in preparation for surgery.  The patient history indicated that a bedside bladder-scan showed 360cc. 
 
 
 
Caption: Sagittal and transverse images of the pelvis
Description: The ultrasound echo pattern is typical for blood clot in a fluid-filled space.
 
Differential Diagnosis Hematoma in urinary bladder
Hematoma in space of Retzius mimicking urinary bladder
 
Final Diagnosis Hematoma in space of Retzius mimicking urinary bladder
 
Discussion This patient presented as a routine case of post op bladder outlet obstruction.  The patient was passing small clots, the bedside bladder scan indicated a distended bladder which could not be emptied on catheterization.  The initial ultrasound image was consistent with this diagnosis, consisting of typical clot echo pattern in a fluid medium.  However, the sonographer noticed that the patient was not in any distress when initially examined, and this was not consistent with the presumptive diagnosis.  On questioning, the patient stated that he was able to periodically urinate a few ml.  On closer examination of the ultrasound image, a structure was noted posterior to the fluid filled space, representing the compressed and displaced urinary bladder.  A large hematoma was filling the space of Retzius (retropubic space) mimicking a distended and clot-filled urinary bladder.  This was confirmed by the CT.
 
Follow Up The patient had a drain inserted suprapubically the following day. Serous fluid and clot were obtained.
 
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