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Renal Trauma
Renal Fracture and Renal Laceration
- Incidence
- Up to 10% of injuries coming to emergency room with
blunt trauma
- Causes
- Motor vehicle accident
- Contact sports
- Falls and fights
- Less often penetrating wounds
- Mechanism
- Direct blow (>80%) frequently compressed and often
lacerated by lower ribs
- Acceleration-deceleration injuries can produce renal
artery tears
- Associated with other organ injury in 20% of cases
- Signs and symptoms
- >95% hematuria
- 25% of patients with gross hematuria have
significant injuries
- But, 24% of patients with renal pedicle injury
have no hematuria
- Only 1-2% with microhematuria have a severe renal injury
- Types of injuries
CT Classification of Renal Trauma |
CT Grade |
Injury |
Usual Treatment |
Grade I |
Superficial cortical laceration, contusion and/or
perirenal hematoma |
Observation |
Grade II |
Deep corticomedullary laceration involving the
collecting system |
Observation or surgery |
Grade III |
Renal crush injury and/or main vascular pedicle injury |
Surgery |
Grade IV |
Injury of the renal pelvis or the ureteropelvic
junction |
Surgery |
- Renal contusion
- Superficial cortical laceration (75-85%)
- Small cortical laceration without calyceal
disruption
- Complete cortical laceration
- Fracture communicating with calyceal system (10%)
- Extraluminal contrast material
- Separation of renal poles or fracture
Contrast-enhanced CT of the mid-abdomen reveals a linear zone of low
attenuation
through the left kidney with surrounding perinephric stranding characteristic
of a deep renal laceration
- Crush injury
- Usually involves injury to the renal vascular
pedicle (5%)
- Multiple separate renal fragments
- Lack of enhancement of part or all of kidney
- Extraluminal contrast material
- Subcapsular hematoma
- Imaging Findings
- Focal patchy areas of decreased enhancement /
striated nephrogram = contusion
- Irregular linear hypodense parenchymal areas = renal
laceration
- Laceration connecting two cortical surfaces =
fracture
- Multiple separated renal fragments ± perfusion =
shattered kidney
- Superficial crescentic hypodense area compressing
adjacent parenchyma = subcapsular hematoma
- Subcapsular / perinephric hematoma usually
proportional to extent of injury
- Wedge-shaped perfusion defect = segmental arterial
injury
- Diffuse non-perfusion of kidney = devascularized kidney
- Persistent nephrogram on delayed scans = renal vein
thrombosis
Injury |
How do you recognize it |
Contusion (75-80%) |
focal patchy areas of
decreased enhancement |
Laceration |
irregular linear hypodense
parenchymal areas |
Fracture |
laceration connecting two
cortical surfaces |
Crush injury |
multiple separated renal
fragments ± perfusion |
Calyceal or pelvic injury |
Extraluminal contrast |
Vascular pedicle injury |
Wedge-shaped or diffuse
non-perfusion of kidney |
Subcapsular hematoma |
superficial crescentic
hypodense area compressing adjacent parenchyma |
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