What is the role of cystography in the workup of enterovesical fistula?

Updated: Dec 24, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Cystography may demonstrate contrast outside the bladder but is less likely to demonstrate a fistula.

Radiographic signs have been described. The herald sign is a crescentic defect on the upper margin of the bladder that is visualized best in an oblique view. The herald sign represents a perivesical abscess. A "beehive on the bladder" sign is associated with the vesical end of the fistulous tract. [45]

Because of the superiority of CT scanning as a tool for diagnosis and treatment planning, plain cystography is no longer used in the evaluation of fistulae. CT scanning with rectal contrast only is the best diagnostic imaging modality.

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