renal trauma

Teenager who
crashed their all terrain vehicle with abdominal painAxial and coronal CT with contrast of the abdomen immediate phase (above) shows low density in the superior and inferior poles of the left kidney and fluid in the left perirenal and pararenal spaces. There is also a large area of low density in the spleen. Delayed phase CT images (below) show extravasation of urine out of the ureter into the left pararenal space.The diagnosis was left renal laceration with ureteral transection and splenic laceration.
pediatricimaging.org • CC-by-nc-sa 4.0
School ager
with right flank pain and hematuria after falling off a table. Coronal (above left) and sagittal (above right) CT with contrast of the abdomen show an extremely dilated right renal collecting system surrounded by an extremely thin rim of renal cortex. The axial image (below) shows high density material within the medial aspect of the renal collecting system.The diagnosis was hemorrhage into a severe right ureteropelvic junction obstruction in a patient with renal trauma.
pediatricimaging.org • CC-by-nc-sa 4.0
Retroaortic
left renal vein • Traumatic renal injury - AAST grade IV injury - Ganzer Fall bei Radiopaedia
Anan, R. Traumatic renal injury - AAST grade IV injury. Case study, Radiopaedia.org. (accessed on 09 Nov 2022) https://doi.org/10.53347/rID-150231 • CC by-nc-sa 3.0 (modified)
Unusual
rupture of a renal cyst. Renal parenchyma distorted by a cyst (11 cm), partially anechoic (green arrows), partially occupied by an inhomogeneous hyperechoic component (orange arrows); perirenal fluid collection (black arrow). Small part of normal renal parenchyma is recognizable (blue arrows).
www.eurorad.org • CC by-nc-sa-4.0
Endovascular
intervention in renovascular disease: a pictorial review. Right renal trauma with persistent haemorrhage of an interlobar artery following a cycling accident demonstrated by angiography (a, white arrow). Therapeutic management consisted of coil embolisation of the injured vessel (b, black arrow)
insightsimaging.springeropen.com • Open Access
Traumatic
haemorrhage in a renal cyst: US and CT findings. Communication of the collecting system with the cyst and contrast material in the cyst.
www.eurorad.org • CC by-nc-sa-4.0
Traumatic
haemorrhage in a renal cyst: US and CT findings. Non-enhancement of the cyst.
www.eurorad.org • CC by-nc-sa-4.0
Computertomographie
einer traumatisch rupturierten Nierenzyste. Man erkennt teilweise noch die Zystenmembran der ursprünglich großen Zyste, aber auch reichlich Flüssigkeit drum herum.
Wikipedia • CC BY-SA 3.0
Unusual
rupture of a renal cyst. Coils positioned in the embolization (blue arrows). The known cyst presents inhomogeneous density (orange arrows), but no changes in density are recognizable after contrast medium administration (Figure b). No contrast medium extravasation is recognizable.
www.eurorad.org • CC by-nc-sa-4.0
Unusual
rupture of a renal cyst. Visualization of the renal cysts (orange arrows, Figures a, b) and of the retroperitoneal haemorrhage (blue arrows, Figures a, b). No urinary leak was recognizable (Figures a, b)
www.eurorad.org • CC by-nc-sa-4.0
Unusual
rupture of a renal cyst. Intracystic haematoma (orange arrows) and fluid collection in the perinephric space (green arrows). Active bleeding with contrast-medium extravasation in the arterial phase (blue arrow Figure b), enlarging on delayed phases (blue arrows Figure c, d)
www.eurorad.org • CC by-nc-sa-4.0
School ager
in a motor vehicle accident. Axial CT with contrast of the abdomen shows a laceration in the posterior aspect of the left kidney. There is isodense fluid in the left perirenal and pararenal spaces.The diagnosis was left renal laceration with perirenal and pararenal hematomas.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Renal trauma can result from direct, blunt, penetrating, and iatrogenic injury.

Epidemiology

Renal injuries account for ~10% of abdominal trauma, and thus the demographic of affected individuals reflect that population. The incidence of renal injuries increases in pre-existing congenital or acquired renal pathology (e.g. horseshoe kidney, renal cysts).

Clinical presentation

Patients tend to present with microscopic or macroscopic hematuria and flank and/or abdominal pain. In more severe cases, hypotension and shock may be present.

The vast majority of isolated renal trauma is minor (95-98%), the low incidence of major renal injuries is explained by the favorable anatomic position of the kidneys, which are located in the retroperitoneum.

Imaging generally should be reserved for the haemodynamically-stable patient; those who are haemodynamically-unstable are often taken directly to the operating theater.

Pathology

Etiology

Blunt trauma from motor vehicle collisions, falls, and personal collisions are the leading cause of renal injury (~85%), the mechanism is from deceleration injuries from a collision of the kidney with the vertebral column or thoracic cage.

Iatrogenic injuries can result from surgery, percutaneous renal biopsy, nephrostomy, and extracorporeal shock wave lithotripsy (ESWL).

Types

The vast majority (95-98%) of renal injuries are minor. The spectrum of renal injuries include:

Associations

Serious renal injuries from blunt and penetrating trauma are associated with multiorgan injuries in ~80% of cases .

Radiographic features

Ultrasound

May detect hemoperitoneum but is not as accurate as CT at diagnosing renal parenchymal injuries .

CEUS

Due to the limited accessibility in the acute setting, and the lack of strong evidence (or expertise) CEUS is currently rarely used in the context of renal trauma. However, in select cases, it can be a valuable tool for problem-solving or follow-up (e.g. to reduce ionizing radiation exposure). The renal cortex demonstrates a rapid and early enhancement normally, followed by that the pyramids. Renal injuries such as lacerations appear as hypoenhancing areas, which are often wedge-shaped. Focal, patchy accumulations of contrast agent microbubbles are highly suggestive of active bleeding. If both kidneys need to be interrogated two separate contrast agent boluses are recommended. It is important to know however that CEUS does not detect collecting system injuries since the microbubbles remain intravascular .

CT

CT is the mainstay for diagnosing renal injuries:

  • CT multiphase protocol study for suspected renal trauma includes a non-contrast phase, an arterial phase to evaluate the vascular injury, a nephrographic phase to evaluate renal parenchymal lesions and a delayed phase to evaluate bleeding and collecting system injuries
  • an alternative protocol study is a portal venous phase followed by a delayed phase to assess for collecting system injury

See the main article renal trauma grading for a detailed description of the AAST classification of renal injuries.

Angiography

CT can provide most of the information required regarding vascular injuries, but angiography can be used to further delineate the area of injury as well as offering the opportunity for treatment with angioembolisation .

Treatment and prognosis

Treatment depends on the specific trauma and complications present.

Complications

Complications affect ~7.5% (range 3-10%) of renal injuries :

Differential diagnosis

Renal tumors can spontaneously hemorrhage, and cause perinephric fluid collection of blood density. These include:

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Nierentrauma:
rupturierte
Nierenzyste Trauma
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Lymphom der
Niere
Wikipedia • CC BY-SA 3.0
Nierenblutung
 
pediatricimaging.org • CC-by-nc-sa 4.0
traumatische
Einblutung Nierenzyste
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