Urinary: Renal Trauma Flashcards
Next step: CT demonstrates renal trauma…
Get excretory phase imaging to see if there is urine leak
Fractured kidney
When a renal laceration connects two cortical surfaces (extending all the way through a kidney)
Shattered kidney
A kidney with at least two fractures, resulting in 3 or more renal fragments
Traumatic injury
Think renal infarction secondary to segmental arterial injury
Note: This is AAST grade 4 renal trauma.
Traumatic injury
Think devascularized kidney due to renal artery injury
Note: This is AAST grade 5 renal trauma.
Traumatic injury
Think left renal vein injury or thrombosis
Note: Persistent nephrogram on the left.
Urinary trauma with focal extra-luminal collections of contrast that decrease in attenuation on delayed excretory imaging…
Think pseudoaneurysm or AV fistula
Note: Active hemorrhage should get more dense on excretory imaging.
AAST grade 1 renal trauma
Subcapsular hematoma without laceration
AAST grade 2 renal trauma
- Mild laceration (<1 cm)
- Perirenal hematoma confined to the perirenal space (within the perirenal fascia)
AAST grade 3 renal trauma
- Moderate laceration (>1 cm) without renal pelvis injury or urine leak
- Active hemorrhage confined to the perirenal space
AAST grade 4 renal trauma
- Severe laceration (i.e. fracture: laceration extends to the renal hilum)
- Segmental infarction due to vascular injury
- Active hemorrhage extending beyond the perirenal space
AAST grade 5 renal trauma
- Shattered kidney
- Renal hilum injury (urine leak or main renal artery/vein injury)
- Devascularized kidney
Which AAST renal trauma grades are generally surgically managed?
Grades 4 and 5
Note: Grades 1, 2, and 3 are generally medically managed.