Renal trauma imaging: Diagnosis and management. A pictorial review

Abstract

SummaryBackgroundThe purpose of this review is to illustrate and discuss the spectrum of imaging findings, particularly computed tomography (CT), of blunt and penetrating renal trauma, based on our own materials, according to the American Association for Surgery of Trauma (AAST) renal injury grading scale. The article also indicates the conditions in which interventional radiology procedures can be applied for the management of renal trauma.Material/MethodCases for this pictorial review were selected from the imaging material collected at the Radiology Department of Hamad Medical Corporation during a 14-year period from 1999 to 2012. The material includes 176 cases (164 males and 12 females) with confirmed blunt or penetrating renal trauma. Following abdominal trauma, all patients had a CT examination performed on admission to the hospital and/or during hospitalization. The most representative and illustrative cases of renal trauma were reviewed according to CT findings and were categorized according to the AAST grading system.DiscusionThe review describes a spectrum of imaging presentations with special emphasis on the 5 grades of renal injury on a CT according to the AAST scale.The most representative cases were illustrated and discussed with indications of possible interventional radiology treatment. Two groups of patients not included in the AAST grading system were presented separately: those with preexisting renal abnormalities and those with sustained iatrogenic renal injury.ConclusionsProper application of renal trauma grading scale is essential for selecting the patients for conservative treatment, surgery or interventional radiology procedure.

A Case of Arteriovenous Fistula After Kidney Trauma Mimicking Tumor

“…The lesions can manifest with a varied range of signs and symptoms such as hypertension or renal masses. 10 The features of Doppler ultrasound are decreased resistive index of the feeding artery and the appearance of arterial waveforms in the outflow vein. Renal veins are frequently dilated if the shunt is large.…”

Bilateral Renal Hypoperfusion Following Motor Vehicle Accident

“… 1 MVAs are the most common cause resulting in sudden deceleration or crush injuries that may affect the renal parenchyma or the vascular pedicle. 1 - 3 The kidney is particularly vulnerable to deceleration injuries (eg, falls, motor vehicle collisions) because it is fixed in space only by the renal pelvis and the vascular pedicle. Flank ecchymosis and broken ribs are signs suggestive of renal injury.…”

“…6 Complete infarction is less common than segmental or subsegmental infarction in patients sustaining blunt trauma. 3 …”

Challenging case of horseshoe kidney double fracture

“…Revised renal injury classification was described by the American Association for the Surgery of Trauma: grade 1, subcapsular hematoma; grade 2, laceration <1 cm in depth into cortex; grade 3, laceration >1 cm in depth into medulla; grade 4, laceration through the corticomedullary junction into the renal collecting system or segmental renal vascular injury with haematoma; grade 5, shattered kidney [3] . A Contrast Enhanced – Multi Detector Computed Tomography (ce-MDCT) scan is the technique of choice for the diagnosis of renal trauma, which allows to detect the grade of renal injury, the presence of associated anomalies, vascular tears, urinary extravasation or theinvolvement of other abdominal organs [4] , [5] , [6] , [7] , [8] . The treatment of renal trauma follows one or a combination of the following pathways: observation only, minimally invasive intervention, or open operative intervention [9] .…”