AAST grade IV kidney injury with CEUS follow-up

Case contributed by Akos Jaray


Fell from horse, then horse rolled on her. Crush injury to right arm, chest and abdomen. Tender epigastric region.

Patient Data

Age: 15 years
Gender: Female

Left kidney: Large triangular avascular area can be noted in the anterior aspect of the midportion of the left kidney in keeping with laceration extending to the renal pelvis including major vascular injury.

Spleen: The lower pole of the spleen shows heterogeneous appearance with hypodense areas in keeping within splenic rupture. 

Pelvic fluid: Large amount of pelvic and lower abdominal fluid is seen (density of 50-60 HU) in keeping with hemoperitoneum.

3 months later


CEUS revealed a 2 cm, wedge shaped avascular area in the mid-portion of the left kidney. Note the fine enhancing subcapsular streak and a few traversing vessels in keeping with ongoing parenchymal remodeling.

Completely homogeneous appearance and diffusely uniform enhancement of the spleen can be seen.

Case Discussion

AAST grade IV kidney injury and splenic rupture with large amount of blood in the pelvis. Patient was stable during hospitalizations; conservative therapy was applied.

3 months later a follow-up CT scan was requested to assess the left kidney morphology and possible remnants of the left kidney injury. Contrast-enhanced ultrasound study was performed given the patient's age in order to avoid unnecessary radiation (according to the ALARA principle).

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