Diagnosis:Grade 4 Renal Trauma
- Noncontrast CT demonstrated large subcapsular hematoma and laceration through the kidney. There is a subtle contrast difference between the kidney and the areas of hemorrhage.
- Contrast CT demonstrated lack of perfusion of most of the lower and mid portions of the right kidney. There are areas of contrast extravasation.
Discussion:Renal trauma is graded according to the American Association for the Surgery of Trauma.
Renal Trauma Grading
- Grade I
- Subcapsular contusion
- Grade II
- Nonexpanding perirenal hematoma confined to retroperitoneum or laceration < 1cm
- Grade III
- Laceration > 1cm parenchymal depth without collecting system rupture
- Grade IV
- Laceration extending through renal cortex, medulla and collecting system. Main renal artery or vein injury with contained hemorrhage
- Grade V
- Completely shattered kidney
- Avulsioin of renal hilum
How Would You Treat This?
B. Partial Nephrectomy
C. Fluid resuscitation including transfusion