|Year : 2021 | Volume
| Issue : 4 | Page : 320-321
High resolution ultrasonography imaging of renal trauma: American association for the surgery of trauma - Renal injury scale grade III
Department of Radiology, St. John's Hospital, Bengaluru, Karnataka, India
|Date of Submission||15-Jun-2021|
|Date of Decision||11-Aug-2021|
|Date of Acceptance||20-Aug-2021|
|Date of Web Publication||11-Oct-2021|
Department of Radiology, St. John's Hospital, Bengaluru - 560 034, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ravikanth R. High resolution ultrasonography imaging of renal trauma: American association for the surgery of trauma - Renal injury scale grade III. Apollo Med 2021;18:320-1
|How to cite this URL:|
Ravikanth R. High resolution ultrasonography imaging of renal trauma: American association for the surgery of trauma - Renal injury scale grade III. Apollo Med [serial online] 2021 [cited 2022 Aug 14];18:320-1. Available from: https://apollomedicine.org/text.asp?2021/18/4/320/327972
| Description|| |
A 32-year-old male presented to the emergency department with sudden-onset severe left flank pain following alleged involvement in a road traffic accident. Pulse, blood pressure, and respiratory rate were within normal limits with no cardiovascular and respiratory compromise. Urinalysis demonstrated numerous red blood cells. Chest radiograph did not demonstrate rib fractures/pneumothorax. The patient was subsequently referred for ultrasonography of the abdomen and pelvis in view of blunt injury to the abdomen, which revealed moderate-sized left-sided perinephric hematoma of approximately volume 140 cc causing compression of renal parenchyma [Figure 1]. Color Doppler examination showed intact vascularity at the renal hilum of the left kidney. There was evidence of linear hypoechoic laceration of 1.5 cm in depth involving the lower pole of the left kidney with concomitant presence of hydronephrosis [Figure 2]. Pelvic intraperitoneal free fluid was noted. However, there was absence of vascular injury and urinary extravasation. The injury was classified grade III based on the American Association for the Surgery of Trauma (AAST) renal injury scale, and the patient was subsequently referred to the department of general surgery for conservative management.
|Figure 1: High-resolution longitudinal ultrasonography image demonstrating moderate sized left sided perinephric hematoma (star) causing compression of renal parenchyma|
Click here to view
|Figure 2: High-resolution longitudinal ultrasonography image demonstrating a linear hypoechoic laceration involving the lower pole of the left kidney with concomitant presence of hydronephrosis (star)|
Click here to view
| Discussion|| |
The absence of urinary extravasation classifies this is as a grade III injury on the AAST renal injury scale. It is only the depth of the renal laceration which differentiates a grade II injury from grade III. This case also illustrates the importance of appropriate protocolling of Focussed Assessment with Sonography for Trauma - the presence of hematuria following a flank injury to allow a prompt decision about further imaging to be made. High-resolution ultrasonography and radionuclide imaging, while advocated in some quarters, do not enjoy worldwide acceptance as first-line triage studies. Standard protocols are useful, but there is a place for flexibility and the customizing of individual approaches.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chong ST, Cherry-Bukowiec JR, Willatt JM, Kielar AZ. Renal trauma: Imaging evaluation and implications for clinical management. Abdom Radiol (NY) 2016;41:1565-79.
Erlich T, Kitrey ND. Renal trauma: The current best practice. Ther Adv Urol 2018;10:295-303.
Chien LC, Herr KD, Archer-Arroyo K, Vakil M, Hanna TN. Review of Multimodality Imaging of Renal Trauma. Radiol Clin North Am 2020;58:965-79.
[Figure 1], [Figure 2]