Penetrating renal trauma (urinoma)

Case contributed by RMH Core Conditions

Presentation

GSW to left chest then hit by car.

Patient Data

Age: 70 years
Gender: Male
Modality: CT

The metallic projectile traversed through the left upper quadrant, lacerated the upper pole of the left kidney.

Numerous locules of the free gas within the peritoneal cavity as well as retroperitoneally and behind the left diaphragmatic crus.

The projectile has eventually stopped adjacent to the left pedicle of L1, just above the intervertebral foramen, with a small psoas haematoma.

There are small locules of gas within the spinal canal, with an impression for increased segmental density anterior to the cord/dura. This can be due to beam hardening artefact and radicular vessels or intraspinal venous plexus; however, possible small epidural collection can not be definitely excluded and correlation with the neurological findings may be of help.

There is a small left para colic and LUQ intra peritoneal fluid which may be urine; however, proximal descending colon is asymmetrically thickened and given the course of the projectile, there is a strong suspicion for injury.

Solid abdominal viscera are otherwise unremarkable. No lymphadenopathy.

Uncomplicated diverticular disease with a loop of the sigmoid colon contained within the left direct inguinal hernia. 

Mildly displaced right L1 and L2 transverse process fractures.

Modality: CT

Moderate amount of urine leakage demonstrated on the delayed images. The resultant small urinoma was noted which appears predominantly contained within the Gerota's/Zuckerkandl's fascia and retro-colic space; however, undoubtedly the fascia is disturbed and communicating with the intraperitoneal cavity.

Case Discussion

Viewing trauma cases whilst the patient remains on the CT table can be a useful exercise as if there is significant renal trauma, a delayed phase can be performed during the same examination instead of needing a repeat examination.

Blunt and penetrating trauma is one of the most common causes for renal leaks and urinomas. In the upper renal tract these can occur from a calyx, infundibulum, renal pelvis or ureter. 

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Case Information

rID: 33577
Case created: 16th Jan 2015
Last edited: 20th Jan 2016
System: Urogenital
Inclusion in quiz mode: Included

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