The Use of Ultrasonography as the Initial Diagnostic Exploration in Blunt Renal Trauma

Abstract

Fifty-four patients with blunt renal trauma underwent abdominal ultrasound as their initial diagnostic exploration if their hemodynamic status and associated injuries did not contraindicate unnecessary delays. Renal ultrasound allowed us to diagnose the injuries and to identify which patients required a more aggressive radiological exploration to obtain a diagnosis of certainty. At the same time we were able to certify that this technique is highly accurate in the diagnosis of lesions associated with gross hematuria. The noninvasiveness and low cost of this procedure makes it, in our experience, the technique of choice in the initial workup of blunt renal trauma.

Tratamento Não Operatório Do Trauma De Vísceras Abdominais Parenquimatosas

“…Entre as principais desvantagens da sua utilização pode-se destacar o fato de ser um exame onde a experiência e o treinamento individual para sua realização são extremamente importantes (operador dependente), a não distinção entre sangue e urina e a difícil avaliação do pedículo renal. 27 A tecnologia atualmente disponível não permite um adequado estadiamento, porém o aperfeiçoamento tecnológico poderá aumentar a participação desta modalidade diagnóstica. É excelente para o seguimento de lesões renais já estadiadas e submetidas ao tratamento conservador ou cirúrgico para diagnóstico de complicações precoces, principalmente as alterações no tamanho dos Pereira Júnior GA, Carvalho JB, Prado Neto GS, Guedes JR http://www.fmrp.usp.br/revista hematomas intra-renal, subcapsular, perirenal ou retroperitoneal, bem como do extravasamento urinário.…”

“…É excelente para o seguimento de lesões renais já estadiadas e submetidas ao tratamento conservador ou cirúrgico para diagnóstico de complicações precoces, principalmente as alterações no tamanho dos Pereira Júnior GA, Carvalho JB, Prado Neto GS, Guedes JR http://www.fmrp.usp.br/revista hematomas intra-renal, subcapsular, perirenal ou retroperitoneal, bem como do extravasamento urinário. 27 A classificação da Organ Injury Scaling (OIS) estabelece o sistema de gravidade de lesão demonstrado na Tabela III. A Figura 3 mostra os vários graus de estadiamento das lesões renais na TC de abdome.…”

Imaging Studies in the Diagnosis of Urogenital Trauma

“…1, 2). However, disadvantages include sonography may not differentiate between blood and urine and is inaccurate as for assessing the renal vasculature [6][7][8].…”

Radiologic Evaluation of Renal Trauma: Part 2

“…Ultrasonography has not yet gained widespread favor in the United States as a primary modality for investigation of renal trauma in adults. Sonographic evaluation for renal and intraperitoneal organ injury has been more frequently performed in Europe [37], because of less accessibility to CT and lower cost. Refinements in image quality and introduction of color flow Doppler technology depict the presence and location of the kidneys, permit evaluation of renal morphology, detect abnormal fluid collections, and allow interrogation of the renal parenchyma for characteristic blood flow patterns.…”

“…Ultrasonography remains an alternative to CT in patients with a history of a significant contrast reaction, or those who are otherwise at high risk for an anaphylactoid or nephrotoxic reaction to IV contrast. The lack of ionizing radiation and typically good visualization of the kidneys in children make US an attractive alternative in the pediatric population to modalities requiring radiation, unless there is a suspicion of a pedicle injury [37]. In the future, more widespread use of intravenous ultrasonographic contrast agents, as well as power Doppler technology, should make evaluation of the renal vasculature more reliably assessable by US.…”