Learning objectives
This poster aims to help the viewer understand the following points in relation to renal trauma:
Indications for imaging in the setting of renal trauma.
Optimal CT protocol for detecting injuries to the renal parenchyma,
vasculature and collecting system.
The American Association for the Surgery of Trauma (AAST) classification system of renal injuries.
CT findings and management options for each grade of injury.
Role of interventional radiology in the management of renal trauma.
Background
Renal injury occurs in approximately 5% of all trauma and in 10% of abdominal traumas.
In the majority of cases,
the renal injury results from blunt trauma (90%) with penetrating injuries comprising only 10% of cases [1,2].
The mechanism of injury in blunt trauma can be due to direct impact or rapid deceleration such as in road traffic accidents (RTAs) or a fall from a height.
While the former mechanism will usually result in injury to the renal parenchyma (contusions,
haematomas and lacerations),
the latter...
Findings and procedure details
Indications for Imaging
Both the European Association of Urology [6] and the American Urologic Association [7] have published guidelines outlining the indications for CT in renal trauma.
Both guidelines broadly agree and can be summarised as follows:
1) Haemodynamically unstable patients should be brought directly to
theatre for exploratory laparotomy.
2) Stable patients who have undergone blunt abdominal trauma and either
a. have gross haematuria
OR
b.
have microscopic haematuria AND evidence of shock i.e.
SBP <
90mmHg
should undergo contrast enhanced CT.
3) Stable...
Conclusion
Radiology plays a central role in the management of renal trauma,
both from a diagnostic and therapeutic viewpoint.
It is vital that an appropriate CT protocol is used when assessing these patients and that the radiologist is familiar with the AAST grading system and the implications for patient management.
Of particular importance is an understanding of how to assess for collecting system injury.
References
1. Bari Dane,
Alexander B.
Baxter,
Mark P.
Bernstein.Imaging
Genitourinary Trauma .
Radiol Clin N Am 55 (2017) 321–335.
2. Suzanne T.
Chong,
Jill R.
Cherry-Bukowiec,
Jonathon M.G.
Willatt,
Ania
Z.
Kielar.
Renal trauma: imaging evaluation and implications for clinical
management.
Abdom Radiol (2016) 41:1565–1579.
3. Kautza B,
Zuckerbraun B,
Peitzman AB.
Management of Blunt Renal
Injury: what is new? Eur J Trauma Emerg Surg (2015) 41:251–258.
4. Shoobridge J,
Corcoran N,
Martin K,
Koukounaras J,
Royce P & Bultitude
M.
Contemporary Management of Renal...