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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 Parenchymal laceration not involving the collecting system (AAST grade II–III). On these 3-mm-thick multiplanar reconstruction (MPR) axial images acquired during the nephrographic (a) and 8-min delayed phase (b) of the study in the same patient, a linear cleft of absent contrast enhancement (arrow) starting from the renal surface and extending deep into the renal parenchyma is clearly appreciable, representing parenchymal laceration. On delayed image (b), no lack of hyperdense urine can be seen, excluding collecting system rupture. A perirenal haematoma (star) coexists posteriorly to the kidney
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Fig3: a–b Parenchymal laceration not involving the collecting system (AAST grade II–III). On these 3-mm-thick multiplanar reconstruction (MPR) axial images acquired during the nephrographic (a) and 8-min delayed phase (b) of the study in the same patient, a linear cleft of absent contrast enhancement (arrow) starting from the renal surface and extending deep into the renal parenchyma is clearly appreciable, representing parenchymal laceration. On delayed image (b), no lack of hyperdense urine can be seen, excluding collecting system rupture. A perirenal haematoma (star) coexists posteriorly to the kidney

Mentions: Parenchymal laceration not involving the collecting system (AAST grade II-III): Parenchymal lacerations (Fig. 3a–b) appear as irregular or linear clefts of absent contrast enhancement, starting from the renal surface and extending deep into the renal parenchyma, and they are best depicted during the nephrographic phase. Their attenuation varies according to their age and the presence of blood clots, and they are usually associated with perirenal haematomas. If a parenchymal laceration is present, delayed acquisitions should be performed in order to rule out urine extravasation (Fig. 3b). Moreover, it is extremely important to exclude the presence of active contrast material extravasation. The AAST subdivides parenchymal lacerations into grade II if they extend less than 1 cm in depth and grade III if they extend more than 1 cm; in any case, there is no difference in the treatment of grade II and III lesions, which must follow the simple “wait-and-see” management. No follow-up imaging studies are required if the clinical and laboratory data remain stable [30–32].Fig. 3


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 Parenchymal laceration not involving the collecting system (AAST grade II–III). On these 3-mm-thick multiplanar reconstruction (MPR) axial images acquired during the nephrographic (a) and 8-min delayed phase (b) of the study in the same patient, a linear cleft of absent contrast enhancement (arrow) starting from the renal surface and extending deep into the renal parenchyma is clearly appreciable, representing parenchymal laceration. On delayed image (b), no lack of hyperdense urine can be seen, excluding collecting system rupture. A perirenal haematoma (star) coexists posteriorly to the kidney
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4376814&req=5

Fig3: a–b Parenchymal laceration not involving the collecting system (AAST grade II–III). On these 3-mm-thick multiplanar reconstruction (MPR) axial images acquired during the nephrographic (a) and 8-min delayed phase (b) of the study in the same patient, a linear cleft of absent contrast enhancement (arrow) starting from the renal surface and extending deep into the renal parenchyma is clearly appreciable, representing parenchymal laceration. On delayed image (b), no lack of hyperdense urine can be seen, excluding collecting system rupture. A perirenal haematoma (star) coexists posteriorly to the kidney
Mentions: Parenchymal laceration not involving the collecting system (AAST grade II-III): Parenchymal lacerations (Fig. 3a–b) appear as irregular or linear clefts of absent contrast enhancement, starting from the renal surface and extending deep into the renal parenchyma, and they are best depicted during the nephrographic phase. Their attenuation varies according to their age and the presence of blood clots, and they are usually associated with perirenal haematomas. If a parenchymal laceration is present, delayed acquisitions should be performed in order to rule out urine extravasation (Fig. 3b). Moreover, it is extremely important to exclude the presence of active contrast material extravasation. The AAST subdivides parenchymal lacerations into grade II if they extend less than 1 cm in depth and grade III if they extend more than 1 cm; in any case, there is no difference in the treatment of grade II and III lesions, which must follow the simple “wait-and-see” management. No follow-up imaging studies are required if the clinical and laboratory data remain stable [30–32].Fig. 3

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