Renal injury - AAST grade V

Case contributed by Henry Knipe


Fall from standing height on to timber beam. Severe pain/tenderness left flank plus over left sided ribs.

Patient Data

Age: 30 years
Gender: Male



There is an AAST grade V left renal laceration (extends to hilum) with devascularisation of medial kidney from the inferior pole to the midpole. There is a moderate-sized left perinephric hematoma with no evidence of active bleeding on these phases. On delayed phase imaging there is no evidence of urine leak. Left renal artery is patent up until its division, beyond this it is difficult to delineate on portal venous images. Small 1.2cm hypodensity at the left midpole. Liver, spleen, right kidney, adrenal glands all appear without traumatic injury. Descending colon is thick-walled but there is normal enhancement and no adjacent fat stranding. Remaining bowel is unremarkable. Undisplaced left lateral 11th rib fracture. No fracture of the lumbar or imaged thoracic spine. Minor dependent consolidation of the left lung base. No pleural effusion or pneumothorax imaged.

Case Discussion

  • AAST grade V left renal injury based on devascularisation of the medial inferior kidney. 
  • Moderate perinephric hematoma with no evidence of active bleeding. 
  • No urine leak identified. 
  • Undisplaced left 11th rib fracture laterally. 
  • Thickwalled descending colon is equivocal for traumatic injury or may be reactive to nearby hematoma.

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