Computerized Tomographic Staging of Renal Trauma: 85 Consecutive Cases

Abstract

In 85 patients with renal trauma we compared the findings on computerized tomography with those of excretory urography, renal surgery, intra-abdominal surgery and angiography. Patients underwent computerized tomography because of a suspected associated thoracic or abdominal injury, or indeterminate findings on excretory urography, nephrotomography or angiography. Blunt trauma accounted for 87.1 per cent of the renal injuries and penetrating trauma for 12.9 per cent. The most common findings on computerized tomography were perirenal hematoma in 29.4 per cent, intrarenal hematoma in 24.7 per cent and parenchymal disruption in 17.6 per cent. In 33 patients who underwent laparotomy computerized tomographic staging was confirmed. In contrast, the most common finding on excretory urography, diminished opacification (17 of 53 patients), was found to have no correlation with the severity of renal injury as assessed by computerized tomography or laparotomy. Angiography appreciably understaged 1 of 5 cases by failing to show extracapsular extravasation with parenchymal disruption. All findings on angiography were depicted by computerized tomography. We conclude that computerized tomographic staging for renal trauma is more sensitive and specific than excretory urography, nephrotomography and angiography, and that it should be used primarily when multiple traumatic injuries are suspected, when excretory urography suggests major trauma or is nonspecific and when clinical evidence of major trauma exists, regardless of what excretory urography shows.

Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

“…Plain abdominal X-rays are not useful, unless is a concern of perforation or obstruction. Intravenous urography and contrast-enhanced CT scan (the preferred imaging method for kidney trauma [27]), are readily available and useful but according to some authors should be avoided, especially in early pregnancy, due to the high radiation exposure and lack of safety evidence [5]. The guidelines of the American College of Obstetricians and Gynaecologists state that an X-ray foetal exposure of less than 5 rads does not increase the risk of foetal anomalies or abortion [28].…”

How to Treat Blunt Kidney Ruptures: Primary Open Surgery or Conservative Treatment with Deferred Surgery When Necessary?

“…Computer tomography provides a noninvasive primary diagnostic tool and affords a reliable follow–up of the injured kidney. Dynamic computer tomography – today the diagnostic procedure of choice in cases with kidney rupture [1, 3]– enables determination of the grade of injury, perfusion of the fragments, urine extravasation and urine flow through the collecting system. An abdominal plain film 20–30 min after the start of computer tomography corresponds to a 20– to 30–min urogram film and completes the diagnostic study of the ureter, which may be insufficient in computer tomogram.…”

“…The introduction of ultrasound and computer tomography in the early 1980s have made the diagnostic procedure and evaluation of the injured kidney easier and better [1, 2, 3]. Not only a better primary workup but also a differentiated follow–up of the injured kidney is possible.…”

Renal Trauma: A Practical Guide to Evaluation and Management

“…For the hemodynamically stable patient, further and more accurate staging can be achieved by a CT scan. 15,16 For the unstable patient with an abnormal IVU, surgical exploration is warranted.…”

“…For the stable patient, renal injury can be most accurately and completely imaged and staged by computed tomography (CT). 15,16 CT imaging is both sensitive and specific for demonstrating parenchymal lacerations, urinary extravasations, delineating segmental parenchymal infarcts, and for determining the size and location of the surrounding retroperitoneal hematoma, and/or associated intra-abdominal injury (spleen, liver, pancreas, and bowel). CT imaging has largely replaced the once standard IVU and arteriogram.…”