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MDCT of blunt renal trauma: imaging findings and therapeutic implications.

Bonatti M, Lombardo F, Vezzali N, Zamboni G, Ferro F, Pernter P, Pycha A, Bonatti G - Insights Imaging (2015)

Bottom Line: To show the wide spectrum of computed tomography (CT) findings in blunt renal trauma and to correlate them with consequent therapeutic implications.Non-operative management, which includes the "watchful waiting" approach, endourological treatments and endovascular treatments, is nowadays widely adopted in blunt renal trauma, and surgery is limited to haemodynamically unstable patients and a minority of haemodynamically stable patients.The interpretation of CT findings in blunt renal trauma may be improved and made faster by the knowledge of their therapeutic consequences. • The majority of blunt renal injuries do not require surgical treatment. • CT findings in blunt renal injury must be evaluated considering their therapeutic consequences. • Some CT findings in blunt renal trauma are not included in the AAST classification.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Bolzano Central Hospital, 5 Boehler St., 39100, Bolzano, Italy, matteobonatti@hotmail.com.

ABSTRACT

Objectives: To show the wide spectrum of computed tomography (CT) findings in blunt renal trauma and to correlate them with consequent therapeutic implications.

Methods: This article is the result of a literature review and our personal experience in a level II trauma centre. Here we describe, discuss and illustrate the possible CT findings in blunt renal trauma, and we correlate them with the American Association for the Surgery of Trauma (AAST) classification and their therapeutic implications.

Results: CT findings following blunt renal trauma can be grouped into 15 main categories, 12 of them directly correlated with the AAST classification and 3 of them not mentioned in it. Non-operative management, which includes the "watchful waiting" approach, endourological treatments and endovascular treatments, is nowadays widely adopted in blunt renal trauma, and surgery is limited to haemodynamically unstable patients and a minority of haemodynamically stable patients.

Conclusions: The interpretation of CT findings in blunt renal trauma may be improved and made faster by the knowledge of their therapeutic consequences.

Teaching points: • The majority of blunt renal injuries do not require surgical treatment. • CT findings in blunt renal injury must be evaluated considering their therapeutic consequences. • Some CT findings in blunt renal trauma are not included in the AAST classification.

No MeSH data available.


Related in: MedlinePlus

a–b Subcapsular haematoma (AAST grade I) (a) and perirenal haematoma (AAST grade II) (b). The 3-mm-thick multiplanar reconstruction (MPR) coronal image (a) acquired during the delayed phase of the study shows a well-delimited hypodense biconvex-shaped collection (star), located between the renal parenchyma and renal capsule, which determines the mild mass effect on the adjacent parenchyma (arrowheads), representing subcapsular haematoma. A similar finding may also be observed in the 3-mm-thick multiplanar reconstruction (MPR) axial image (b) acquired during the nephrographic phase in another patient in which, however, an irregularly delimited inhomogenously hypodense collection, representing perirenal haematoma (arrowheads), is appreciable between the renal parenchyma and the Gerota fascia. In both cases neither parenchymal lacerations nor active contrast material extravasations can be observed
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Fig2: a–b Subcapsular haematoma (AAST grade I) (a) and perirenal haematoma (AAST grade II) (b). The 3-mm-thick multiplanar reconstruction (MPR) coronal image (a) acquired during the delayed phase of the study shows a well-delimited hypodense biconvex-shaped collection (star), located between the renal parenchyma and renal capsule, which determines the mild mass effect on the adjacent parenchyma (arrowheads), representing subcapsular haematoma. A similar finding may also be observed in the 3-mm-thick multiplanar reconstruction (MPR) axial image (b) acquired during the nephrographic phase in another patient in which, however, an irregularly delimited inhomogenously hypodense collection, representing perirenal haematoma (arrowheads), is appreciable between the renal parenchyma and the Gerota fascia. In both cases neither parenchymal lacerations nor active contrast material extravasations can be observed

Mentions: Subcapsular haematoma (AAST grade I). Subcapsular haematoma (Fig. 2a–b) appears as a well-delimited, non-enhancing fluid collection located between the renal parenchyma and the renal capsule. Depending on its size, the collection may show a crescent or a biconvex shape; in the latter case, a mass effect is usually exerted on the adjacent parenchyma, which may become flattened or indented. The attenuation of the collection varies according to its age, and hyperdensity may be seen if blood clots are present. To be classified as a grade I lesion, a subcapsular haematoma must not be associated with parenchymal lacerations and no active contrast material extravasation should be observed; indeed, subcapsular haematomas are often associated with higher grade parenchymal lesions. Moreover, if a capsular lesion coexists, the haematoma often extends to the perirenal space (Fig. 2b). A simple “wait-and-see” management is indicated in case of subcapsular haematoma, and no follow-up imaging studies are required if the clinical and laboratory data remain stable [30–32].Fig. 2


MDCT of blunt renal trauma: imaging findings and therapeutic implications.

Bonatti M, Lombardo F, Vezzali N, Zamboni G, Ferro F, Pernter P, Pycha A, Bonatti G - Insights Imaging (2015)

a–b Subcapsular haematoma (AAST grade I) (a) and perirenal haematoma (AAST grade II) (b). The 3-mm-thick multiplanar reconstruction (MPR) coronal image (a) acquired during the delayed phase of the study shows a well-delimited hypodense biconvex-shaped collection (star), located between the renal parenchyma and renal capsule, which determines the mild mass effect on the adjacent parenchyma (arrowheads), representing subcapsular haematoma. A similar finding may also be observed in the 3-mm-thick multiplanar reconstruction (MPR) axial image (b) acquired during the nephrographic phase in another patient in which, however, an irregularly delimited inhomogenously hypodense collection, representing perirenal haematoma (arrowheads), is appreciable between the renal parenchyma and the Gerota fascia. In both cases neither parenchymal lacerations nor active contrast material extravasations can be observed
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4376814&req=5

Fig2: a–b Subcapsular haematoma (AAST grade I) (a) and perirenal haematoma (AAST grade II) (b). The 3-mm-thick multiplanar reconstruction (MPR) coronal image (a) acquired during the delayed phase of the study shows a well-delimited hypodense biconvex-shaped collection (star), located between the renal parenchyma and renal capsule, which determines the mild mass effect on the adjacent parenchyma (arrowheads), representing subcapsular haematoma. A similar finding may also be observed in the 3-mm-thick multiplanar reconstruction (MPR) axial image (b) acquired during the nephrographic phase in another patient in which, however, an irregularly delimited inhomogenously hypodense collection, representing perirenal haematoma (arrowheads), is appreciable between the renal parenchyma and the Gerota fascia. In both cases neither parenchymal lacerations nor active contrast material extravasations can be observed
Mentions: Subcapsular haematoma (AAST grade I). Subcapsular haematoma (Fig. 2a–b) appears as a well-delimited, non-enhancing fluid collection located between the renal parenchyma and the renal capsule. Depending on its size, the collection may show a crescent or a biconvex shape; in the latter case, a mass effect is usually exerted on the adjacent parenchyma, which may become flattened or indented. The attenuation of the collection varies according to its age, and hyperdensity may be seen if blood clots are present. To be classified as a grade I lesion, a subcapsular haematoma must not be associated with parenchymal lacerations and no active contrast material extravasation should be observed; indeed, subcapsular haematomas are often associated with higher grade parenchymal lesions. Moreover, if a capsular lesion coexists, the haematoma often extends to the perirenal space (Fig. 2b). A simple “wait-and-see” management is indicated in case of subcapsular haematoma, and no follow-up imaging studies are required if the clinical and laboratory data remain stable [30–32].Fig. 2

Bottom Line: To show the wide spectrum of computed tomography (CT) findings in blunt renal trauma and to correlate them with consequent therapeutic implications.Non-operative management, which includes the "watchful waiting" approach, endourological treatments and endovascular treatments, is nowadays widely adopted in blunt renal trauma, and surgery is limited to haemodynamically unstable patients and a minority of haemodynamically stable patients.The interpretation of CT findings in blunt renal trauma may be improved and made faster by the knowledge of their therapeutic consequences. • The majority of blunt renal injuries do not require surgical treatment. • CT findings in blunt renal injury must be evaluated considering their therapeutic consequences. • Some CT findings in blunt renal trauma are not included in the AAST classification.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Bolzano Central Hospital, 5 Boehler St., 39100, Bolzano, Italy, matteobonatti@hotmail.com.

ABSTRACT

Objectives: To show the wide spectrum of computed tomography (CT) findings in blunt renal trauma and to correlate them with consequent therapeutic implications.

Methods: This article is the result of a literature review and our personal experience in a level II trauma centre. Here we describe, discuss and illustrate the possible CT findings in blunt renal trauma, and we correlate them with the American Association for the Surgery of Trauma (AAST) classification and their therapeutic implications.

Results: CT findings following blunt renal trauma can be grouped into 15 main categories, 12 of them directly correlated with the AAST classification and 3 of them not mentioned in it. Non-operative management, which includes the "watchful waiting" approach, endourological treatments and endovascular treatments, is nowadays widely adopted in blunt renal trauma, and surgery is limited to haemodynamically unstable patients and a minority of haemodynamically stable patients.

Conclusions: The interpretation of CT findings in blunt renal trauma may be improved and made faster by the knowledge of their therapeutic consequences.

Teaching points: • The majority of blunt renal injuries do not require surgical treatment. • CT findings in blunt renal injury must be evaluated considering their therapeutic consequences. • Some CT findings in blunt renal trauma are not included in the AAST classification.

No MeSH data available.


Related in: MedlinePlus