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Traumatic renal artery pedicle stretch injury

Case contributed by Michael P Hartung
Diagnosis certain


Motor vehicle accident with ejection from the vehicle.

Patient Data

Age: 40 years
Gender: Male

Trauma scan


The main and accessory left renal arteries becomes discontinuous shortly after the vascular pedicle arises from the abdominal aorta. There is some distal opacification of a few renal vessels. This is consistent with several intimal injuries of the main and accessory renal arteries.

There are multiple areas of non-enhancement throughout the left kidney, consistent with infarcts.

There are strandy blood products in the renal hilum and periaortic region, consistent with hemorrhage in the setting of vascular stretch injury.

Delayed phase images were obtained, with absent opacification of the collecting system, suggesting that the kidney has been largely devascularized and is nonfunctional.


14-year follow-up imaging


This is a 14-year follow-up to the original trauma scan.

The left kidney is now atrophic and contains multiple calcifications. No discernible arterial flow is present in the left kidney, indicating that following the injury 14 years previously, complete occlusion of the main vasculature has occurred. A minimal amount of flow to the left kidney evidenced by mild cortical enhancement and flow within the renal vein is likely due to a few small accessory vessels which are not well identified.

Case Discussion

This is a classic appearance for traumatic renal artery pedicle stretch injury, which occurs during rapid deceleration, not blunt abdominal trauma. As a result of rapid deceleration, there is a stretch injury to the intima, which is less elastic when compared to the media and adventitia, which results in occlusion of the renal vasculature. This results in multiple infarcts within the left kidney. The retroperitoneal/perinephric hemorrhage is likely due to a combination of venous and arterial extravasation. Delayed images demonstrate no concentration of urine within the left kidney, suggesting that it is largely devascularized and nonfunctional. This finding is confirmed the 14 year follow-up, where the left kidney is markedly atrophic.

A companion case with nearly identical findings and expanded discussion can be found here.

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