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Renal and adrenal trauma
Dr Tim FotheringhamThe Royal London Hospital, UK
Nordic Trauma Society, Oslo 2008
Renal trauma
Renal trauma
• 1-5% of all traumas• Common in other settings
– Iatrogenic eg biopsy– Childbirth
• 80-95% are due to blunt trauma• Avulsion seen with vertical deceleration
Associated injuries
• Other organ injury seen in approx 75%• Spleen 25% with left kidney injury• Lower rib fractures• Lumbar spine injuries
Findings
• Haematuria• Flank pain• Rib/lumbar process fracture• Abrasion or bruising to the flank• Abdominal distention• Abdominal mass• Abdominal tenderness
Pre-existing renal disease
• Renal injury is more common with pre-existing renal disease
• Horseshoe kidney• Pelvic kidney• Renal cysts• Benign and malignant renal lesions
Sensitivity of imaging
• US 79%• IVP 91%• CT 96%• Comparison study 498 patients
– Qin R et al Chin J Traumatol 2002
Renal injuries• Use of Ultrasound
– May be diagnostic in children– Follow-up in children
• Ultrasound findings– Perirenal fluid– Hypoechoeic line– Loss of renal sinus echoes– Absence of doppler
CT findings
• Blurring of fat planes• Focal contusions• Subcapsular haematoma• Perirenal haematoma• Lacerations • Pseudoanuerysms/active bleeding• Devascularised kidney• PC leaks
Grading AAST• I Subcapsular haematoma or contusion• II Cortical laceration <1cm• III Cortical laceration >1cm• IV Deep laceration (may include collecting
system)Segmental infarction
• V Multiple major lacerationsAvulsionVenous thrombosis
Grade I
Grade II
Grade III
Grade IV
Grade V
Isolated penetrating trauma
• Frequently iatrogenic• Angiography indicated for haemorrhage
control• Aneurysms and AVM can frequently be
managed using endovascular techniques
Penetrating injury to loin
Ureteric injuries
• <1% of urological injuries
• 5% with pelvic fracture
• 17% have haematuria• Nephrostomy and
ureteric stenting• Cystoscopic stening• Surgery
Adrenal injury
• Haemorrhage common• Usually incidental observation
Conclusion
• Renal injuries are common• 80% Grade I-III• Non operative management • Surgery indicated for haemorrhage control• Nephrostomy indicated for leak from
collecting system
Irish Scarecrow