A 17-year-old male presented with stab wound at left flank. He was sent

for evaluation.

1

A crescentic shape fluid, measuring about 55 HU, around left kidney which could be perinephric hematoma.

Arterial phase Venous phase Delayed KUB

2

Wedge shape hypodensity lesion at left kidney

Delayed KUB : Extravasation of contrast to pelvocaliceal system

Renal parenchymal laceration extending through cortex,medulla and pelvocaliceal system

3

Air bubble at retroperitoneal space along stab wound track

Delayed KUB : Extravasation of contrast to pelvocaliceal system

4

Ureter without extravasation of contrast media

5

6

Laceration at upper pole of the left kidney in posterior aspect

Findings• Penetrated tract with subcutaneous

emphysema at the left flank through upper to mid pole of the left kidney.

• Extravasation of contrast from pelvocaliceal system

• Renal parenchymal laceration extending through cortex,medulla and pelvocaliceal system

• Crescentic shape fluid, which could be perinephric hematoma of the left kidney.AAST grading category IV

RENAL TRAUMA

Pornprom Thungkatikajonkit ,MD.

Renal trauma

• Blunt trauma 90% – Motor vehicle accidents , fall.– Vehicle collision at high speed : Deceleration injury

-> major vascular injury.• Penetrating trauma 10% – Gunshot wounds– Stab wounds

Indication for radiological evaluation

• Gross hematuria.• Microscopic hematuria with hypotension.• Penetrating trauma with any degree of hematuria• Children (<16 years)• Injuries associated with renal injury – Direct contusion– Hematoma of flank soft tissue– Fractures of lumbar spine, lower ribs and transverse

process.

Imaging modality

• Contrast-enhanced CT• Single-shot intraoperative Intravenous

urography(IVU)• Ultrasonography• Angiogram

Imaging modality

• Contrast-enhanced CT Scan: Modality of choice – Parenchymal lacerations– Vascular injuries– Perinephric hematomas– Extravasation of contrast-enhanced urine– Associated injuries

Imaging modality

American Association for surgery of trauma injury scale

www.aast.org

American Association for surgery of trauma injury scale

www.acssurgery.com

Grade IV : lacerations

- Deep lacerations extendingthrough the kidney into the collecting system.

- Extravasation of urine and urinary contrast in delayed phase axial CT

Diagnostic radiology genitourinary imaging 3rd edition

Grade V : Shattered kidney

Gross renal parenchymal disruption secondary to multiple renal lacerations show non enhancing devitalized areas due to renal infarction(vascular injuries)

Diagnostic radiology genitourinary imaging 3rd edition

Grade V : Devascularized kidney

- No ehnacement of the left renal parenchyma. - Vascular pedicle injury that disrupted the renal artery resulting in a totally avascular left kidney.

https://www.med-ed.virginia.edu/courses/rad/gu/kidneys/contusion.html

Grade V : UPJ injury

Contrast enhanced (left) and delayed (right) CT scans demonstrating stranding and fluid around the mid left ureter, and a left UPJ injury respectively

http://www.biomedcentral.com/1471-2490/8/3/figure/F2

Management

• Stable grade I-III injuries– Managed non-operatively.

• Severe grade IV-V– Required careful selection based on• Hemodynamic stability• Mechanism – penetrating injury• Associated non-renal injuries

• Isolated penetrating renal injury in stable patient can be managed conservatively

Management

• Therapeutic angiographic interventions for transcatheter embolization of ongoing hemorrhage in renal trauma in hemodynamically stable patients.

References• Niranjan Khandelwal MD, editors. Diagnostic radiology genitourinary imaging 3rd

edition, Jaypee Brothers Medical Publishers (P) Ltd;2009.• Raquel Cano Alonso, MD. Kidney in Danger: CT Findings of Blunt and Penetrating

Renal Trauma. Radiographics. November 2009;volume29 , issue7.• www.acssurgery.com• www.aast.org• http://www.wjgnet.com/1949-8470/full/v5/i8/275.htm• https://www.med-ed.virginia.edu/courses/rad/gu/kidneys/contusion.html• http://www.biomedcentral.com/1471-2490/8/3/figure/F2

Further reading

Questions