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CLINICAL IMAGES Table of Contents  
Ahead of print publication
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

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Date of Submission15-Jun-2021
Date of Decision11-Aug-2021
Date of Acceptance20-Aug-2021
Date of Web Publication11-Oct-2021
 


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 [Epub ahead of print] [cited 2021 Nov 30]. Available from: https://www.apollomedicine.org/preprintarticle.asp?id=327972





  Description Top


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

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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)

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  Discussion Top


The absence of urinary extravasation classifies this is as a grade III injury on the AAST renal injury scale.[1] It is only the depth of the renal laceration which differentiates a grade II injury from grade III.[2] 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.[3] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
    
2.
Erlich T, Kitrey ND. Renal trauma: The current best practice. Ther Adv Urol 2018;10:295-303.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
    

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Correspondence Address:
Reddy Ravikanth,
Department of Radiology, St. John's Hospital, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/am.am_76_21



    Figures

  [Figure 1], [Figure 2]



 

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