Blunt Trauma

Blunt renal injuries consist of contusion, laceration, rupture, and injury to the renal pedicle. Ureter rupture due to blunt trauma is rare. Most ureteral injury is from gunshot and stab wounds. Renal trauma should be suspected in a setting of shock, hematuria, or adjacent fractures. Several studies have correlated the lack of hematuria with absence of major urinary tract injury, yet occasional patients without hematuria do have urinary tract injury, especially to the renal pedicle and ureter, and the degree of hematuria does not correlate with the extent of the injury eventually detected. Even a major
ureteral laceration does not lead to hematuria in about one third of patients. Leakage from the urinary tract results in an accumulation of urine and either a urinoma or urinary ascites ensue. The presence of hematuria, on the other hand, is generally investigated further with imaging studies. Often not only is urinary tract
injury present but also multi organ damage.
Incidentally, not all red urine represents blood. Porphyrins and certain drugs and foods lead to red-colored urine. About 15% of the population has a genetic predisposition to beeturia, due to the betalaine red pigment found in beet root. In children, the kidney is the most common organ injured in blunt abdominal trauma.Complicating the issue is that congenital malformations need be considered. Thus underlying hydronephrosis or even an extrarenal pelvis predisposes to a laceration or avulsion. A rare cause of nontraumatic ureteral hematoma is overcoagulation.
Intravenous urography is no longer the primary imaging modality for renal trauma, having been supplanted by CT, which also evaluates other intraabdominal structures. If CT is not readily available, urography is an alternate for evaluating the upper urinary system. A normal IV urogram essentially excludes major renal and ureteral injury, although rare instances of severe renal laceration have not been detected with an urogram.
Limited urography, consisting of a scout radiograph, a radiograph shortly after contrast injection, and perhaps another one in 5 minutes or so (called “one-shot urography” by some clinicians) is a fast study to assess gross renal function and establish that there are indeed two kidneys in an unstable patient, but it is inadequate to assess for underlying renal trauma and should be discouraged in stable patients. It is a useful study in unstable patients who then undergo immediate exploration; their renal status is determined intraoperatively. Many trauma patients have multiple injuries and, in the United States and some other countries, if they are hemodynamically stable, contrast-enhanced helical CT has become the screening tool of choice. Precontrast images are generally not obtained. An early-phase CT evaluates
the renal pedicle and overall vascularity, a parenchymal-phase CT detects renal lacerations, and a delayed-phase CT provides information about contrast excretion and possible extravasation. Such a technique also evaluates injury to the liver, spleen, pancreas, and adjacent structures. In particular, one should not rely on early-phase images to exclude collecting system injury with contrast extravasation; delayed scans are necessary. At times delayed serial postcontrast views reveal an increasing CT density or MR signal intensity in adjacent fluid, confirming extravasation. In some countries US is the primary imaging modality in evaluating renal trauma. Ultra
sonography can detect major vascular injury, renal fracture, or gross extravasation. It is a common modality in children. Nevertheless, accuracy of US appears to be less than with CT and even iv urography. Currently MRI is not the initial imaging modality in suspected renal trauma, with availability, cost, and imaging time delays being some of the factors involved. Nevertheless, MRI complements CT in some trauma patients, especially those with equivocal CT findings, those who need repeat imaging studies, and those with an iodine allergy. Ureteropelvic junction avulsion consists of complete ureteral transection, and thus no contrast is identified in the distal ureter, but contrast extravasation is evident, often perirenal in location. Although ureter nonvisualization is at times even a normal finding, in the appropriate clinical setting such a finding suggests avulsion, and a more specific study of ureter integrity, such as retrograde pyelography, should be considered. Both contrast extravasation and contrast in the ureter distally signify an ureteropelvic junction laceration. These findings are detected with both urography and postcontrast CT, but in any one patient the differentiation between avulsion and laceration can be difficult. Differentiation between avulsion and laceration has therapeutic implications
because the latter is often managed conservatively.
At times a preexisting abnormality alters an otherwise more typical appearance of renal trauma. A renal cyst is prone to rupturing during blunt abdominal trauma, and the patient develops either hematuria or retroperitoneal hemorrhage. Such trauma-induced rupture of a renal cyst modifies the appearance of an associated hematoma. Ultrasonography identifies an acute hematoma as an isoechoic or hyperechoic tumor mimicking a neoplasm; it becomes more heterogeneous during resolution. Renal scintigraphy has a role in detecting urinary leaks in patients with a contraindication to IV contrast. It is also often employed in renal transplant patients.
Radiology images of perirenal hematoma. A: CT identifies left perirenal fluid in a man who fell down stairs. B: Contrast-enhanced CT in another patient reveals a focal fluid collection anterior to the left kidney (arrows).

Artikel Terkait

Blunt Trauma
4/ 5


Suka dengan artikel di atas? Silakan berlangganan gratis via email

This below all content of radiology information

Neuroradiology Musculoskeletal radiology MRI Musculoskeletal MRI Abnormal Mri Brain X-RAY differential diagnosis Head Neck Anatomy mnemonic CT Teleradiology Radiology News chest Radiology musculoskeletal salary pediatrics ultrasound ultrasound images job Brain tumour abdomen interventional radiology Apk Android CT Abdomen with contrast DAMS Imaging radiology ramblings residency c nature pediatric radiology random ramblings xray C T Radiology Top basics body imaging guide procedure web 2.0 Chest X Ray Interpretation Teleradiology Providers head and neck radiology video Fun Ultrasound Hepatitis b cancer chest radiology salary 1 CXR GenitoUrinary ORTHOPEDICS Sonographic Measurements Stroke dams md/ms coaching mammography radiology business tuberculosis BRAIN Clinicoradiological series FETUS GI radiology Gastrointestinal x ray Radiology 4 Radiology Conferences Radiology Images Telemedicine UPPER LIMPS Ultrasound in Emergencies dynamic MRI lifestyle radiology links renal case spine 3 tesla MRI Dams clinicoradiological series Entrepreneur Gastrointestinal Tract Images Literature Liver abscess ultrasound MD/MS coaching Radiology 40 Radiology Imaging Radiology Journal Radiology PDF Radiology mcqs Ultrasound Technique blog bone tumour cardiac CT career cerebral venous thrombosis chest xray d fracture gadolinium gastrointestinal genitourinary radiology hepatobiliary imaging lipoma medical blogs mri lower abdomen pelvis psychiatry radiation concern social networking technology training urogenital imaging weblog 3D CT Arachnoid cyst CT Cardiac Chest X Ray Diploma Guid Equipment Cost FDA Fibrous dysplasia Interventional Ultrasound Guiding Biopsi MDCT MR Pancreas MRI Vertebrae MRI Vertebrae lumbal MRI contrast MRS RTA Radiology Teaching resource TB Hip TECHNIQUE Tech Thorax X Ray Upper Ext aiims ankle sprain bowel cancer brain abscess case study computers and radiology contrast ependymoma epidermoid facebook guest post internet journal of radiology iphone kienbock disease liver liver segments ct locum tenens mri abdomen multislice CT pericallosal lipoma plain film teaching files private practice radiology humour shoulder arthrogram shoulder dislocation small bowel social media trigeminal neuralgia tuberous sclerosis venous x ray Vertebrae 3d printing 7 tesla MRI ACL reconstruction ACL tear ACLS AIIMS nov 2008 ALPSA lesion ANGIOGRAPHY ATFL B12 deficiency BLS BOLD Breast imaging Breast imaging Mammography CHF CT Paranasal CT Scanner Price CT angiography CT coronary angiography CT technology CV junction CXR teaching files Carcinoid Contrast Agent Creutzfeldt-Jakob Disease Dams MD/ms Dams grand rounds Diffusion weighted imaging Dysmenorrhea E E World Award 2011 EYE Embolization Imaging Entrepreneurship FMG India FMGE FNH Focal liver lesions ultrasound Focal nodular hyperplasia GBM GI Gall bladder Glioblastoma multiforme Glomus jugulare HEAD HEART HRCT HSG Head injury ICA dissection IRIA 2011 IUGR IVC filter Iliotibial Band Friction Syndrome Job Info Kidney Cancer LV thrombus Leptomeningeal cyst MAMOGRAPHY MCI Screening MD MPPG MR mammography MR urography MRA MRCP MRI Cervical MRI update MRI/PET MRV Mesenteric ischemia Middle East respiratory syndrome coronavirus (MERS-CoV) Motor neuron disease NECK Normal Liver US Oncology trial PDF Radiology PM and R Physician PNS Partial anomalous pulmonary venous drainage Persistent trigeminal artery Pg entrance Physiatrist Physiatry Physician Assistant Plastic Surgery Price MRI Machines 2017 Pulmonology Pulvinar sign Radiology Price List Radiology Today Radiology Updates Radiology grandrounds Radiology images of GI Tract Renal Ultrasound Retinal Surgery Rheumatology Ryles tube SKULL Seizure Sellar Masses Sleep Medicine Sports Medicine Subdural hematoma Surgery TBM TRIANGULAR FIBROCARTILAGE COMPLEX Trauma Surgery URI Ultrasound HIV Umbilical vein Update Article Upper Extremity X Ray Urology Usmle VHL Vascular Surgery Veteran Affairs X Ray Head about accessory bone acute cerebillitis acute pancreatitis aiims may 2011 aipg ankle ankle fracture apple articular cartilage aspergilloma atherosclerosis avulsion injury awards bankart lesion basilar artery thrombosis bilateral phaeochromocytoma biopsy bipolar bohler's angle bone tumours brachial plexus brain tb brainstem stroke branchial cyst breast cancer screening buford complex business today calcaneal fracture calcium scoring canned reports carcinoma esophagus carcinoma stomach cardiac ct/pet cardiac pacemaker cardiogen 82 cardiothoracic imaging catrotid artery dissection cavernoma cervical lymphnode levels chest radiographic score chest radiographs choledocolithiasis classification cloud computing cochlear implant colloid cyst communication in radiology compare case concha bullosa congenital brain anomalies congenital heart disease coronary CT coronary artery disease corpus callosum agenesis craniopharyngioma cryptococcal meningitis ct abdomen and pelvis cystic renal disease dams usmle dams visual treat deep brain stimulator dengue dengue hemorrhagic fever developmental dysplasia devices diagnostic imaging dialysis diffusion MR imaging diffusion tensor imaging diffusion tractography digital radiography distal facial neuroma dsa duplication gall bladder echinococcus echocardiography ectopic kidney elearning elevated diaphragm epilepsy esop facial neuroma fibular osteosarcoma functional mri gastrointenstinal tuberculosis germinoma gifts glioma google google plus gun shot injury haemangioblastoma health 2.0 healthcare consultancy hemangiblastoma hemophilia hippocampus hirayama disease hydatid cyst hypercoagulable hypoxic ischemic encephalopathy indian conferences inferior rectus anomaly infrared interior tomography interstitial lung disease intramedullary metastates intramedullary tuberculomas ipad ipad 2 jacoud's arthropathy kernohan's notch knee kohler's disease krukenberg tumour laceration leber's optic atrophy liver transplant lung contusion lymphatics macros marchifava bingami disease mastoiditis maxillary sinus mucocele medial malleolus ossicle medial tibial stress syndrome medical writting medicare medicolegal aspects of teleradiology migraine mortality motor area mri knee mri lumbal msk penang course mucinous cystadenoma multicentric Glioblastoma multiforme mycotic pseudoaneurysm of superficial temporal artery nephrogenic systemic fibrosis nephrology neurosurgery meets nonradiologist oesophagus olecranon spur online medical games open access opercular syndrome opinion orbit os odontoideum os radiale externum osirix osteochondritis osteochondroma osteoid osteoma outsourcing radiology ovarian tumour parameniscal cyst paranasal sinuses parotid vascular mass patellar sleeve avulsion fracture patent ductus arteriosus patent foramen ovale patient information pelvic MRI pericardial fat phaeochromocytoma pharmaceutical writting pineal tumour placenta accreta placenta increta placental insufficiency pneumococcal pneumonia polycystic kidney disease portal Hypertension posterior circulation stroke power point presentation primary complex protected health information pseudobulbar palsy pseudomyxoma peritonei publications pulmonary edema pulmonary embolism pulmonary tuberculosis rabbit ear sign rad radiographic deterioration pattern radiography radiolo radiologist blogs radiology city radiology debate radiology images of spleen radiology intervensional radiology learning radiology search engine radiology spotter radiology spotters radiolopolis raditudes rathke cleft cyst renal imaging renal sinus tumour right sided aortic arch robot round cell tumour sacral agenesis scaphoid fracture schatzki ring scientific content screening search engine secondaries secondary ossification centres silicosis social radiology soft tissue chondroma solitary pulmonary nodule spectroscopy spinal arachnoid cyst spinal cord tumours spinal osteochondroma spine tumour spinoglenoid cyst sternal tuberculosis stress fracture sacrum stroke mri sub-acute combined degeneration subclavian pseudoaneurysm subependymal giant cell astrocytoma sumer sethi swyer-james syndrome syringomyelia tb teaching video teleradiolo teleradiology business models teleradproviders teleultrasound temporal bone fracture tendoachilles testicular tumour tethered cord. MRI tibial stress fracture total knee arthroplasty total shoulder replacment trachea. tracheal diverticulum tracheal stenosis tracheomalacia traumatic lung cyst triceps tear triquetral fracture tubercular abscess tuberculoma tuberculosis elbow ultrasound image of The segments of the liver umblical artery doppler uroradiology vascular malformation vasovist venous angioma ventriculitis video ct scan video mri viral encephalitis vitamin deficiency