Renal Trauma
Injury to the kidney is seen in approximately 8–10 % of patients with blunt or penetrating abdominal injuries [1]. The vast majority (80–90 %) of cases involve blunt rather than penetrating injury. Renal trauma is usually associated with the involvement o
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Renal Trauma Libero Barozzi, Diana Capannelli, Massimo Valentino, and Michele Bertolotto
7.1
Introduction
Injury to the kidney is seen in approximately 8–10 % of patients with blunt or penetrating abdominal injuries [1]. The vast majority (80– 90 %) of cases involve blunt rather than penetrating injury. Renal trauma is usually associated with the involvement of other organs, such as spleen and liver. Trauma is classified into major or minor trauma depending on the severity of the injury, the location of damage, or a combination of both.
L. Barozzi (*) Radiology Unit, Casa di Cura Madre Fortunata Toniolo, Via Toscana 34, Bologna 40141, Italy e-mail: [email protected] D. Capannelli Radiology Unit, Cardio Thoracic Vascular Department, University of Bologna, Policlinico Sant’OrsolaMalpighi, Via Massarenti 9, Bologna 40138, Italy e-mail: [email protected] M. Valentino Radiology Department, Tolmezzo Hospital, Via Morgagni 18, Tolmezzo (UD) 33028, Italy e-mail: [email protected]
Major trauma occurs in injuries with complex dynamics (road accidents, falls from height), and usually multi-organ involvement occurs, while minor trauma is caused by localized forces that act with a small kinetic force and cause only confined damage. Renal involvement in abdominal trauma is usually suspected on the base of the presence of hematuria, location of impact, wounds, or multiple fractures of the lower ribs. Hematuria is present in almost 80 % of cases with renal injury; however, hematuria may be absent in patients with main renal artery thrombosis and devascularization [2]. The protocol for the management of patients with suspected renal injury divides patients into three groups: 1. Hemodynamically instable patients: surgical exploration; patients stabilized after initial poor scores: CT scan or repeat FAST 2. Hemodynamically stable patients with hematuria: CT scan 3. Hemodynamically stable patients with no hematuria and negative FAST: follow-up with clinical observation of at least 6 h duration [2]
M. Bertolotto Radiology Department, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, Trieste 34149, Italy e-mail: [email protected] © Springer International Publishing Switzerland 2017 P. Martino, A.B. Galosi (eds.), Atlas of Ultrasonography in Urology, Andrology, and Nephrology, DOI 10.1007/978-3-319-40782-1_7
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7.2
Diagnostic Imaging
In major trauma, hemodynamically unstable patients on admission are most likely going to surgery immediately. In other cases, radiological imaging plays an important role in the detection of organ damage. Contrast-enhanced multi-detector computed tomography (CE-MDCT) is the gold standard in the evaluation of patients with high-energy abdominal trauma, because of high spatial resolution, very fast execution, and higher sensibility. CE-MDCT also allows excluding active bleeding, multitraumatic involvement of deep organs (pancreatic trauma), and gut perforations. In the acute management of trauma, ultrasonography (US) plays a role only
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