Emergency ultrasound diagnosis of traumatic renal cyst rupture
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CASE REPORT
Emergency ultrasound diagnosis of traumatic renal cyst rupture Brooks Walsh • Darrell Sutijono Christopher L. Moore
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Received: 7 December 2009 / Accepted: 5 March 2010 / Published online: 7 April 2010 Ó Springer-Verlag 2010
Abstract Renal cyst rupture secondary to trauma is a rare occurrence. A case is reported of a ruptured renal cyst after a fall in a 79-year-old man with a history of multicystic kidney disease. The focused sonographic findings of the renal cyst rupture are described.
(Philips EnVisor, Andover, MA), and revealed multiple large cystic structures associated with both kidneys. An anechoic collection was noted posterior and medial to the right kidney and contiguous with a cyst, but did not track into Morison’s pouch (Fig. 1; Online Resource 1).
Keywords Ultrasound FAST Trauma Renal cyst rupture Emergency
Results and discussion
Case report A 79-year-old man presented to the emergency department complaining of right flank pain after falling down two stairs. His past medical history was significant for multicystic kidney disease, chronic renal failure, hypertension, and abdominal aortic aneurysm repair. The patient’s vital signs were stable. On physical exam, his right flank and right posterior chest wall were tender, but no crepitus, deformity, or ecchymosis was noted, lungs were clear and equal bilaterally, and the abdomen was soft without tenderness. A focused assessment with sonography for trauma (FAST) examination was performed by the emergency physician using a 5–2 MHz curvilinear array transducer
A subsequent computed tomography scan of the abdomen confirmed a ruptured right renal cyst with associated retroperitoneal fluid posterior to the right kidney (Fig. 2). No intra- or extra-renal hemorrhage was noted. The patient was admitted by the Trauma Surgery service for observation and had an uncomplicated hospital course. While experimental models have suggested that the presence of renal cysts and hydronephrosis increase the likelihood of renal injury in blunt trauma [1], reports of
Electronic supplementary material The online version of this article (doi:10.1007/s13089-010-0023-6) contains supplementary material, which is available to authorized users. B. Walsh D. Sutijono (&) C. L. Moore Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT 06519, USA e-mail: [email protected]; [email protected]
Fig. 1 Coronal view of the right hepatorenal window illustrating the liver (L), the kidney (K) with multiple renal cysts, and an anechoic area consistent with retroperitoneal free fluid (arrow). Note that it is continuous with one of the renal cysts
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Fig. 2 Transverse views of the computed tomography scan of the abdomen, illustrating right renal cysts with surrounding soft tissue stranding and retroperitoneal fluid
posttraumatic renal cyst rupture is rare [2–5]. Rupture into the pyelocalyceal system, retroperitoneum, peritoneum, and perinephric and s
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