renal trauma bua finish
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A 17-year-old male presented with stab wound at left flank. He was sent
for evaluation.
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A crescentic shape fluid, measuring about 55 HU, around left kidney which could be perinephric hematoma.
Arterial phase Venous phase Delayed KUB
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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
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Air bubble at retroperitoneal space along stab wound track
Delayed KUB : Extravasation of contrast to pelvocaliceal system
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Ureter without extravasation of contrast media
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Laceration at upper pole of the left kidney in posterior aspect
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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
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RENAL TRAUMA
Pornprom Thungkatikajonkit ,MD.
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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
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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.
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Imaging modality
• Contrast-enhanced CT• Single-shot intraoperative Intravenous
urography(IVU)• Ultrasonography• Angiogram
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Imaging modality
• Contrast-enhanced CT Scan: Modality of choice – Parenchymal lacerations– Vascular injuries– Perinephric hematomas– Extravasation of contrast-enhanced urine– Associated injuries
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Imaging modality
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American Association for surgery of trauma injury scale
www.aast.org
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American Association for surgery of trauma injury scale
www.acssurgery.com
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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
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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
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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
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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
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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
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Management
• Therapeutic angiographic interventions for transcatheter embolization of ongoing hemorrhage in renal trauma in hemodynamically stable patients.
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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
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Further reading
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Questions
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