CT
Axial C+ portal venous phase
Which findings can be congruent with an AAST grade IV kidney injury?
Laceration with urinary extravasation (urography phase might be needed to prove). Ureteropelvic disruption. Segmental renal vessel injury. Segmental infarctions. Active bleeding into the retroperitoneum or peritoneum.
Left kidney: Large triangular avascular area can be noted in the anterior aspect of the midportion of the left kidney in keeping with laceration extending to the renal pelvis including major vascular injury.
Spleen: The lower pole of the spleen shows heterogeneous appearance with hypodense areas in keeping within splenic rupture.
Pelvic fluid: Large amount of pelvic and lower abdominal fluid is seen (density of 50-60 HU) in keeping with haemoperitoneum.