Type:
Educational Exhibit
Keywords:
Abdomen, Trauma, Emergency, CT, CT-Angiography, Education
Authors:
S. Hapugoda, P. Bekhit, C. Hacking; QLD/AU
DOI:
10.26044/ranzcr2019/R-0079
Imaging findings OR Procedure details
The updated renal injury scale as per the 2018 revision is as follows (2):
Grade I:
Grade II:
Grade III:
-
parenchymal laceration (depth: >1 cm) without collecting system rupture or urinary extravasation
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any injury in the presence of a renal vascular injury (thrombosis, pseudoaneurysm or AV fistula) or active bleeding contained within perirenal fascia
Grade IV:
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parenchymal laceration extending into urinary collecting system with urinary extravasation
-
renal pelvis laceration and/or complete ureteropelvic disruption
-
segmental renal vein or artery injury
-
active bleeding beyond perirenal fascia into retroperitoneum or peritoneum
-
segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
Grade V:
-
main renal artery or vein laceration or avulsion of hilum
-
devascularised kidney with active bleeding
-
shattered kidney with loss of identifiable parenchymal renal anatomy
*Each additional injury denotes an increase in grade, up to grade III.
In addition to pseudoaneurysm and AV fistula, the presence of vascular thrombosis is also now constitutes a type of vascular injury (grade IV). Collecting system injury has been added as a grade IV injury, and renal devascularisation with active bleed now included in grade V. Grade I and II criterion are unchanged. In regard to the CT protocol, an arterial and venous phase is recommended, with a delayed excretory phase if renal injury is suspected or confirmed.