Prevesical Fluid Collection

Because of the orientation of the umbilicovesical fascia, a prevesical fluid collection has a "molar tooth" configuration in an axial plane.285 The "crown" portion of the tooth lies anterior to the urinary bladder between the umbilicovesical fascia and transversalis fascia of the anterior abdominal wall and displaces the bladder posteriorly. The "roots" portion extends posteriorly between the fascia and either the peritoneum superiorly or the parietal pelvic fascia inferiorly, displacing the bladder medially (Fig. 8-232). or away from the midline if the roots are asymetrical in size (Fig. 8-233). When there is a very large collection, the upper portion extends toward the umbilicus and appears as a round, midline mass displacing the bowel.

Presacral Fluid Collection

Fig. 8—231. Paravesical hematoma due to coagulation defect.

CT in a female patient demonstrates that the hematoma is localized in the left paravesical space (star) with compression of the urinary bladder (Ub) to the right and extension posteriorly into the presacral fat (arrow). Note the hematoma in the right anterolateral abdominal wall.

Paravesical Space

Fig. 8-232. Prevesical hematoma secondary to crash injury.

CT scan in a male.

(a) "Molar tooth" configuration (star). The "crown" portion of the tooth lies anterior to the urinary bladder, displacing it posteriorly. The "root" portion of the molar extends posteriorly and symmetrically compresses the lateral portions of the bladder. Note that the normal perivesical space is maintained (small arrow). There is an extension into the presacral fat (large arrow).

(b) Cephalad extension into the prevesical space (star).

Fig. 8-232. Prevesical hematoma secondary to crash injury.

CT scan in a male.

(a) "Molar tooth" configuration (star). The "crown" portion of the tooth lies anterior to the urinary bladder, displacing it posteriorly. The "root" portion of the molar extends posteriorly and symmetrically compresses the lateral portions of the bladder. Note that the normal perivesical space is maintained (small arrow). There is an extension into the presacral fat (large arrow).

(b) Cephalad extension into the prevesical space (star).

As many as 3 L of fluid may occupy the prevesical space and its extensions without evidence of a palpable abdominal wall mass. The space has multiple potential extensions and communications. These include extensions into the extraperitoneal region of the abdomen (such as the posterior pararenal space), into the rectus sheath, along the round ligaments or the vas deferens and spermatic cord, into the femoral sheath, and posteriorly into the presacral space (Fig. 8-231). Many of these communications allow bidirectional spread. Rectus sheath hematomas below the arcuate line extend into the prevesical space to displace and compress the pelvic viscera, and postpuncture hematomas in the femoral sheath can expand rapidly to fill the prevesical space.284

Space Retzius Tumor

Fig. 8-233. Prevesical hematoma secondary to crash injury.

(a) A large hematoma asymmetrically occupies the prevesical space (star). Bleeding into the anterior abdominal wall has also occurred (arrow).

(b) Caudal extension is defined within the space of Retzius (star).

Fig. 8-233. Prevesical hematoma secondary to crash injury.

(a) A large hematoma asymmetrically occupies the prevesical space (star). Bleeding into the anterior abdominal wall has also occurred (arrow).

(b) Caudal extension is defined within the space of Retzius (star).

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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