Renal trauma: AAST grade IV injury
Intoxicated, fell. Right sided abdominal pain and haematuria.
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Two separate lacerations of the right kidney extending through the whole depth of the kidney parenchyma. No arterial images but the renal artery and vein look intact. Extensive right perinephric haematoma and blood in right retroperitoneal space. On delayed images, extravasation of contrast around the proximal right ureter in keeping with urine leak. No other injuries.
The combination of perinephric haematoma, parenchymal lacerations and urine leak classifies this as a grade IV injury on the American Association for the Surgery of Trauma (AAST) renal injury scale. There is a strong association between right kidney/liver injuries and right sided rib fractures with underlying lung trauma and pneumothoraces.
In addition, an arterial phase assessment of the solid organs in trauma is extremely useful. Therefore, starting the trauma CT with an arterial phase acquisition of the chest and abdomen is standard in most trauma centres.