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Renal Fracture
Renal Laceration 

  • Incidence
    • Up to 10% of injuries coming to emergency room with blunt trauma
  • Cause
    • Motor vehicle accident
    • Contact sports
    • Falls and fights
    • Less often penetrating wounds
  • Mechanism
    • Direct blow (>80%) frequently compressed and often lacerated by lower ribs
    • Acceleration-deceleration injuries can produce renal artery tears
  • Associated with other organ injury in 20% of cases
  • Signs and symptoms
    • >95% hematuria
      • 25% of patients with gross hematuria have significant injuries
      • But, 24% of patients with renal pedicle injury have no hematuria
      • Only 1-2% with microhematuria have a severe renal injury
  • Types of injuries

 

CT Classification of Renal Trauma

CT Grade

Injury

Usual Treatment

Grade I

Superficial cortical laceration, contusion and/or perirenal hematoma

Observation

Grade II

Deep corticomedullary laceration involving the collecting system

Observation or surgery

Grade III

Renal crush injury and/or main vascular pedicle injury

Surgery

Grade IV

Injury of the renal pelvis or the ureteropelvic junction

Surgery


 

    • Renal contusion
    • Superficial cortical laceration (75-85%)
    • Small cortical laceration without calyceal disruption
    • Complete cortical laceration
      • Fracture communicating with calyceal system (10%)
        • Extraluminal contrast material
        • Separation of renal poles or fracture

Contrast-enhanced CT of the mid-abdomen reveals a linear zone of low attenuation
through the left kidney with surrounding perinephric stranding characteristic of a deep renal laceration

    • Crush injury
      • Usually involves injury to the renal vascular pedicle (5%)
      • Multiple separate renal fragments
        • Lack of enhancement of part or all of kidney
      • Extraluminal contrast material
    • Subcapsular hematoma
  • Imaging Findings
    • Focal patchy areas of decreased enhancement / striated nephrogram = contusion
    • Irregular linear hypodense parenchymal areas = renal laceration
    • Laceration connecting two cortical surfaces = fracture
    • Multiple separated renal fragments perfusion = shattered kidney
    • Superficial crescentic hypodense area compressing adjacent parenchyma = subcapsular hematoma
      • Subcapsular / perinephric hematoma usually proportional to extent of injury
    • Wedge-shaped perfusion defect = segmental arterial injury
    • Diffuse non-perfusion of kidney = devascularized kidney
    • Persistent nephrogram on delayed scans = renal vein thrombosis

 

Injury

How do you recognize it

Contusion (75-80%)

focal patchy areas of decreased enhancement

Laceration

irregular linear hypodense parenchymal areas

Fracture

laceration connecting two cortical surfaces

Crush injury

multiple separated renal fragments perfusion

Calyceal or pelvic injury

Extraluminal contrast

Vascular pedicle injury

Wedge-shaped or diffuse non-perfusion of kidney

Subcapsular hematoma

superficial crescentic hypodense area compressing adjacent parenchyma