Answer

Blunt renal trauma

There is a laceration from the cortical surface through the parenchyma of the right kidney communicating with the hilum - renal fracture. There is perinephric haemorrhage and fluid surrounding the kidney. The kidney remains well perfused. In addition, there is a laceration through the right lobe of the liver.

The majority of renal injuries are from blunt trauma. Flank pain, bruising and haematuria can accompany renal trauma but are a poor indicator of the extent of disease. Renal pedicle injury or traumatic renal vein thrombosis can present with no associated haematuria. It is necessary to correlate clinical findings with the mechanism and severity of trauma.

The role of imaging is to assess the extent of injury - trauma grading (see Table 3.2) and to determine the function of the contralateral kidney. 149

Table 3.2 Grading of blunt renal trauma (American Association of

Surgeons in Trauma)

1. Renal contusions and subcapsular haematoma

2. Cortical laceration less than 1 cm in depth and non-expanding perirenal haematomas

3. Parenchymal lesion extending more than 1 cm into renal substance, extension into the collecting system or evidence of urinary extravasation

4. Lacreation involving the collecting system, traumatic thrombosis of a segmental renal arterial branch, and injuries to the main renal artery not associated with renal devascularisation

5. Renal fragmentation or renovascular pedicle injury

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