Renal trauma - US and IVP

Case contributed by Alejandra Herrera


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



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


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.

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