Page 3

Diagnosis:

Grade 4 Renal Trauma

Findings:

  • 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?

A. Nephrectomy
B. Partial Nephrectomy
C. Fluid resuscitation including transfusion
D. Embolization

BackNext
 
print button
WP3