Traumatic renal artery dissection and pancreatic transection


When trauma to the kidneys is identified whilst the patient is on the CT scanner, it is advisable to do a delayed scan through the collecting system to assess for a leak. Whilst this was performed in this case, no contrast was excreted into the left collecting system so an injury could not be excluded.  

Devascularisation of the kidney is an AAST Grade 5 injury. It is an uncommon occurrence, occurring in 2.5-4% of traumatic renal injuries. Management for renal artery injury is controversial. There are three main options 1:

  • nephrectomy - only in well patients with two kidneys
  • vascular repair
  • conservative monitoring: can be complicated by renovascular hypertension 2

CT findings of pancreatic injury can be subtle initially however early diagnosis is critical in reducing morbidity and mortality. Main pancreatic duct disruption is the greatest predictor for complications. Direct findings of pancreatic injuries include: enlargement of the pancreas; a laceration (focal linear non-enhancement); comminution (fracture) and inhomogeneous enhancement. Secondary findings include: peripancreatic fluid and stranding; fluid between the splenic vein and pancreas; peripancreatic hemorrhage; thickening of the left anterior pararenal fascia and injuries to adjacent structures.