Presentation
An unrestrained passenger involved in a motor vehicle accident presented with blunt abdominal trauma, abdominal pain and frank hematuria.
Patient Data
CT abdomen demonstrates a left renal cortical laceration with multiple pseudoaneurysms and a contained perinephric hematoma. Active contrast extravasation indicates ongoing bleeding. These findings suggest a high-grade renal injury, AAST Grade 4, requiring urgent intervention. On delayed imaging, excretion of urine is demonstrated and indicates underlying collecting system injury. On the visible portion of the chest in this dedicated abdominal scan, there is left lower lobe posterior segment consolidation and pleural effusion.
Digital subtraction angiography (DSA) images of the left kidney show multiple intracortical renal arterial upper and midpole branch pseudoaneurysms, with the catheter tip positioned in the proximal left renal artery. Post-intervention, coil embolization is demonstrated with three coils successfully occluding the upper, mid and lower pole pseudoaneurysms, confirming the successful treatment.
Case Discussion
CT arteriography demonstrated a significant left renal, cortical laceration, contrast extravasation, and multiple branch vessel pseudoaneurysms. Digital subtraction angiography confirmed the pseudoaneurysms, which were treated with coil embolization. Subsequently, the patient developed post-traumatic renovascular hypertension, with blood pressures averaging 190/100 mmHg, necessitating antihypertensive therapy.
Interventional radiology (IR) is integral in managing blunt renal trauma, particularly high-grade injuries. It offers a minimally invasive alternative to surgery, with selective arterial embolization being the preferred technique for controlling hemorrhage, treating pseudoaneurysms, and preserving renal function 1. Digital subtraction angiography facilitates precise localization of vascular injuries, allowing for targeted embolization with coils, and reducing the need for a nephrectomy.
Post-traumatic renovascular hypertension is a known complication of blunt renal trauma, often due to pseudoaneurysms or renal arterial stenosis, leading to impaired perfusion and activation of the renin-angiotensin-aldosterone system (RAAS) 2. This condition requires early intervention through angiography and embolization or stenting, alongside medical management to control blood pressure and prevent long-term renal and cardiovascular complications.
No further imaging or feedback is available regarding the sequela of the left kidney and renal collecting system.
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