The importance of computed tomography in the management of renal trauma

Abstract

Background: Contrast-enhanced computed tomography (CE-CT) has become the imaging modality of choice for evaluating abdominal trauma and has replaced the intravenous urography as the primary modality for assessing suspected renal injuries. The aim of this study was to assess the value of CE-CT in the management of renal trauma. Material and methods: The study included 11 patients aged 4 to 17 years who underwent CE-CT for assessment of renal trauma at the Institute for Mother and Child Health Care between May 2016 and February 2018. Results: CE-CT has allowed grouping renal injuries into five grades of severity according to the American Association of Surgeons in Trauma organ injury severity scale (grade 1 – parenchymal contusions and isolated subcapsular hematomas; grade 2 – superficial cortical lacerations < 1 cm in depth and nonexpanding perirenal hematomas; grade 3 – lacerations > 1 cm in depth without extension into the collecting system or evidence of urinary extravasation; grade 4 – deep lacerations that involve the collecting system, traumatic arterial thrombosis or urinary extravasation; grade 5 – shattering of the kidney into multiple fragments and devascularizing injuries of the renal pedicle. In this study, 45% of patients had grade 3 renal injuries, 36% – grade 4 renal injuries and 18% – grade 5 renal injuries. The obtained details about the injured anatomical structures proved indispensible for guiding the treatment strategy and surgical interventions. Conclusions: Computed tomography provides valuable information in the evaluation of renal trauma, guiding the treatment strategy and surgical interventions in selected patients.