Renal trauma - AAST grade V injury

Case contributed by Dr Walid Al-Deeb

Presentation

Came off bike downhill.

Patient Data

Age: 25 years
Gender: Male

There is complete separation of the upper and lower half of the right kidney by approximately 6cm. The fracture extends through the right renal pelvis. A large peri- and para-nephric hematoma on the right extends to the anterior mesentery, perihepatic, right paracolic gutter and to the pelvis. Contrast is seen in the proximal right renal vein which then fades off hence suggesting transection at this site. The ascending colon is displaced medially. There is good enhancement of the upper and lower right renal poles. Appearances are consistent with a grade 5 American Association for the Surgery of Trauma (AAST) injury to the right kidney.

Normal appearances of the liver, gallbladder, spleen, pancreas, adrenals and left kidney. No bone fracture within the region scanned.

CT Chest (not included above was normal).

Annotated image
  1. Note good renal cortical enhancement which suggests arterial perfusion.
  2. Complete separation of the upper and lower renal pole.
  3. Site of right renal vein transection (arrow). 

Case Discussion

Most grade I to IV injuries can be treated conservatively, thus avoiding unnecessary surgery.
Surgery is indicated for :

  • vascular (renal pedicle) injury
  • shattered kidney
  • expanding or pulsatile hematoma
  • shocked polytrauma patient

Our case was reviewed by the local trauma unit. The plan was for conservative management as the patient was haemodynamically stable.

Case contributed by Dr A Kraus.

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Case information

rID: 40756
Published: 3rd Nov 2015
Last edited: 5th Jan 2021
Inclusion in quiz mode: Included