Renal trauma in pregnancy

Case contributed by Dr Craig Hacking

Presentation

MVA. Abdominal pain and tenderness. Positive seat belt sign. 20 weeks pregnant. Bedside ultrasound showing IUFD.

Patient Data

Age: 25 years
Gender: Female
CT
  • single intrauterine gestation, fetus and uterus appear intact. Heterogenous enhancement of the placenta.
  • right-sided retroperitoneal haemorrhage extending into the pelvis
  • small volume of pelvic free fluid
  • right proximal ureteric dilatation and wall hyperdensity suggestive of injury, normal enhancement of the right kidney with no parenchymal injury detected
  • small right renal artery aneurysm
  • subcut fat stranding in keeping with the seat belt sign
CT

CT urogram

Large volume of contrast extravasation in the right retroperitoneum, from a renal pelvis laceration extending into the PUJ.

Case Discussion

The patient was treated with ureteric stenting and recovered well.

Renal collecting system injury is at higher risk in pregnancy due to the physiological hydronephrosis and hydroureter from the gravid uterus.

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Case information

rID: 57957
Published: 24th Jan 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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