Urinary: Renal Trauma

Question 1

Next step: CT demonstrates renal trauma…

Answer 1

Get excretory phase imaging to see if there is urine leak

Question 2

Fractured kidney

Answer 2

When a renal laceration connects two cortical surfaces (extending all the way through a kidney)

Question 3

Shattered kidney

Answer 3

A kidney with at least two fractures, resulting in 3 or more renal fragments

Question 4

Traumatic injury

Answer 4

Think renal infarction secondary to segmental arterial injury

Note: This is AAST grade 4 renal trauma.

Question 5

Traumatic injury

Answer 5

Think devascularized kidney due to renal artery injury

Note: This is AAST grade 5 renal trauma.

Question 6

Traumatic injury

Answer 6

Think left renal vein injury or thrombosis

Note: Persistent nephrogram on the left.

Question 7

Urinary trauma with focal extra-luminal collections of contrast that decrease in attenuation on delayed excretory imaging…

Answer 7

Think pseudoaneurysm or AV fistula

Note: Active hemorrhage should get more dense on excretory imaging.

Question 8

AAST grade 1 renal trauma

Answer 8

Subcapsular hematoma without laceration

Question 9

AAST grade 2 renal trauma

Answer 9

• Mild laceration (<1 cm)
• Perirenal hematoma confined to the perirenal space (within the perirenal fascia)

Question 10

AAST grade 3 renal trauma

Answer 10

• Moderate laceration (>1 cm) without renal pelvis injury or urine leak
• Active hemorrhage confined to the perirenal space

Question 11

AAST grade 4 renal trauma

Answer 11

• Severe laceration (i.e. fracture: laceration extends to the renal hilum)
• Segmental infarction due to vascular injury
• Active hemorrhage extending beyond the perirenal space

Question 12

AAST grade 5 renal trauma

Answer 12

• Shattered kidney
• Renal hilum injury (urine leak or main renal artery/vein injury)
• Devascularized kidney

Question 13

Which AAST renal trauma grades are generally surgically managed?

Answer 13

Grades 4 and 5

Note: Grades 1, 2, and 3 are generally medically managed.