Splenic and renal injuries

Case contributed by Dr Andrew Dixon

Presentation

Car accident.

Patient Data

Age: 60 years
Gender: Male
CT

High grade splenic injury with multiple lacerations, serveral areas of active contrast extravasation, perisplenic haematoma and haemoperiteoneum in both upper quadrants and the pelvis. There is a small laceration to the anterior aspect of the left renal mid-to-upper pole with fluid stranding around the left renal pelvis. No renal vascular injury seen.   

CT

Given the renal injury detected on the art/PV phase scan, the patient remained on the CT table and a delayed phase CT was performed. This shows injury to the left renal pelvis with irregular contour to the excreted contrast, however there remains communication with the ureter and drainage.  

Case Discussion

A nice case example of the "corridor of impact" concept in blunt trauma. The splenic injury is obvious in this case, however, it is always important to look at surrounding structures for less obvious injuries, such as the left renal injury in this case. This case also demonstrates the utility of keeping patients on the scanner for a delayed scan in the setting of renal trauma to assess for urine leak. 

This patient was successfully managed with proximal splenic artery embolisation for the splenic injury and the renal injury was managed conservatively with follow-up CT intravenous pyelogram showing no development of a urinoma.    

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Case information

rID: 55483
Case created: 9th Sep 2017
Last edited: 9th Sep 2017
Systems: Trauma, Urogenital
Inclusion in quiz mode: Included

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