Renal trauma - US and IVP

Diagnosis certain

Citation, DOI, disclosures and case data

Citation:

Herrera A, Renal trauma - US and IVP. Case study, Radiopaedia.org (Accessed on 28 Sep 2023) https://doi.org/10.53347/rID-174285

DOI:

https://doi.org/10.53347/rID-174285

Permalink:

https://radiopaedia.org/cases/174285

rID:

174285

Disclosures:

At the time the case was submitted for publication Alejandra Herrera had no financial relationships to ineligible companies to disclose.

View Alejandra Herrera's current disclosures

Case published:

19 Sep 2023

Revisions:

11 times, by 3 contributors - see full revision history and disclosures

Systems:

Trauma, Urogenital

Quiz mode:

Excluded

Presentation

The patient presented with a 5-day history of right lumbar pain and hematuria following a 3-meter fall.

Patient Data

Age: 30 years

Gender: Male

Renal

From the case: Renal trauma - US and IVP

ultrasound

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Right Kidney

Images 1-3: laceration (7.7 cm) in the interpolar kidney associated with an anechoic structure that corresponds to a confined fluid collection.

Image 4: diminished Doppler response observed on the superior renal segment.

Image 5: about 195 ml of free fluid is seen in Mrrison's pouch.

Left kidney

Image 6: Multiple hyperechogenic structures with acoustic shadows are seen in the renal calyces corresponding to a staghorn calculus.

Trace free fluid was observed in the right illiac fossa

"One-shot" IV pyelogram

From the case: Renal trauma - US and IVP

x-ray

Normal nephrographic and pyelographic phases are bilateral. No hydronephrosis or hydroureter is seen. On the left renal silhouette, five radiopaque structures are seen that correspond to the staghorn calculus.

No contrast leakage is seen in the abdominal cavity.

Case Discussion

On initial assessment, the patient presented with hypovolemic shock. An abdominal US was performed, with findings suggesting right renal trauma associated with free fluid in Morison`s pouch as well as a left renal staghorn calculus.

Before taking the patient to the OR, due to hemodynamically unstable status, a "one-shot" pyelogram was requested since no CT scan was available at that time. Normal nephrographic and pyelographic phases are seen in both kidneys. The left renal staghorn calculus is identified. No hydronephrosis or hydroureter was observed during the study.

The patient underwent a renorrhaphy, and during the procedure, a duplicated bilateral collecting system is found. On the right side, one of the ureters has severe injuries. On the left side, one of the ureters was completely obstructed by the staghorn calculus. These findings correlate to the "one-shot" pyelogram images.

Although "one-shot" pyelograms are rarely used nowadays since the introduction of CT, they are a good alternative in cases where CT scans are not readily available. It can also be used during surgery to assess renal excretion.

A CT scan allows for the grading of renal trauma based on renal trauma classification by the American Association for the Surgery of Trauma (AAST) ¹.

References

2 public playlists include this case

Urology by Emil Michalski
trauma by Emil Michalski

Renal trauma - US and IVP

Citation, DOI, disclosures and case data

Presentation

Patient Data

Renal

"One-shot" IV pyelogram

Case Discussion

References

2 public playlists include this case

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Renal trauma - US and IVP

Citation, DOI, disclosures and case data

Presentation

Patient Data

Renal

"One-shot" IV pyelogram

Case Discussion

References

2 public playlists include this case

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