Radiologic Evaluation of Renal Trauma: Part 1

Abstract

A variety of radiologic investigations exist for the evaluation of patients with suspected renal trauma. The decision to undertake a particular radiologic study should be based on the mechanism of injury (blunt versus penetrating), likelihood of associated intraperitoneal injury, age and stability of the patient, and presence of hematuria. Adult patients with blunt trauma who are hemodynamically stable and exhibit only microscopic hematuria typically do not require radiologic evaluation, while any stable patient with penetrating trauma to the flank region should undergo an imaging study regardless of the results of a urinalysis. The great majority of renal injuries are mild, consisting of contusions, small hematomas, and superficial lacerations. Deep lacerations, fractures, sizable hematomas or urinomas, and limited urinary extravasation all are more significant injuries for which computed tomography (CT) has proven to be useful in detection and therapeutic planning. Severe injuries such as traumatic renal artery occlusion, ureteropelvic junction (UPJ) disruption, and “shattered” kidney all mandate intervention either to salvage or remove the injured kidney. Radiologic techniques can be both diagnostic and therapeutic in many of these situations. Transcatheter embolization of bleeding vessels and percutaneous drainage of urinomas are examples of the definitive or adjunctive roles which interventional radiology has now assumed in many centers.