Traumatic renal injury with pseudoaneurysm and coiling

Case contributed by RMH Core Conditions


Pedestrian vs. car.

Patient Data

Age: 65 years
Gender: Male

The retroperitoneal hematoma has increased significantly in size from prior CT (not shown), now extending to the pelvis. Furthermore the fluid surrounding the liver is of a higher density than would be expected for pure serous transudate (it measures 25-30 HU) and is likely at least blood-stained. There is no clear source for the intraperitoneal blood, with the splenic injury thought to be quite minor and the fluid collecting remote to the spleen. Bowel injury may be present, although there are no CT features of this at this stage. Filling defects are present at the renal pelvis on the delayed imaging, which in this context is likely to represent blood clots. No evidence on CT of urine leak or active contrast extravasation. These findings have been discussed with the urology and trauma teams. The patient has been referred for DSA +/- embolization. 

Traumatic left renal injury with a fracture through the lower pole is again demonstrated. The inferior segment of the left kidney has been devascularised and there is no contrast enhancement of the parenchyma. Further lacerations are again demonstrated in the interpolar region. No peritoneal free gas. 

Tiny hiatus hernia, otherwise the stomach is unremarkable. The adrenals, right kidney, small bowel and colon are unremarkable. The gallbladder is contrast opacified, presumably residual from the previous CT. IDC is in situ.

Minimally displaced fractures of the anterior right 6th and 7th, and lateral left 8th ribs noted. Minimally displaced left L3 transverse process fracture.

Left proximal false aneurysm from inferior pole large branch - minimal extravasation from within the aneurysm, no clear transected vessel identified. Lower pole suspicious for occluded branch - but selective examination showed no extravasation or aneurysm.

Progreat via cobra - IDC 3*15 retrieved as too long - 3*6 occluded false aneurysm - small prolapse of coils managed with coronary 3*9mm integrity stent placement. NO extravasation/false aneurysm still filling at end of procedure. Stable. Right Normal - no false aneurysm or extravasation.

Case Discussion

Injuries sustained:

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