Bladder flap hematoma is a hematoma between the uterus and posterior wall of urinary bladder. They may be small (more commonly) or large (>5 cm, less common).
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Clinical presentation
Small hematomas may be asymptomatic. Large ones may present with lower abdominal pain, dysuria, anemia and fever if infected.
Pathology
It is an uncommon complication of cesarean section, due to bleeding and uterine dehiscence, usually at the transverse lower uterine incision. It has also been reported with longitudinal incisions.
Radiographic features
Ultrasound
The hematoma presents as a heterogeneous solid region with a variable amount of fluid component. Presence of gas foci strongly suggests infected hematoma or an abscess. US is less useful in demonstrating the dehiscence.
CT
May show slightly hyperattenuating fluid density in between the posterior wall of bladder and uterus, however, MRI is preferred over CT.
MRI
It has the ability to distinguish the blood products (see: aging blood on MRI) and abscess. Sagittal and axial images have been very useful in demonstrating transverse lower uterine and longitudinal incisional dehiscence respectively.
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