Majority of blunt trauma injuries present with hematuria
Renal pedicle injuries and penetrating injuries to ureter may not cause hematuria
Renal injuries are associated with flank hematoma, lower rib fracture, penetrating wounds to flanks
Who to image?
Penetrating Trauma
Any degree of hematuria
Blunt Trauma
Gross hematuria
Hypotension and any degree of hematuria
Child with >50rbc/HPF
High index of suspicion for renal trauma
Deceleration injuries even with no hematuria
Multiple trauma patient
CT with IV contrast is the gold standard in assessing renal and GU trauma
More sensitive and specific than IVP, ultrasound, or angiography
However, can miss significant injuries to the renal pelvis, collecting system and ureter given CT generally obtained before contrast is excreted in the urine.
If initial CT shows high grade renal injury (grade IV of V), UPJ injury, or concern for ureteral injury, should obtain additional 10 minute delayed CT
Exception to using IVP over CT is perioperatively in unstable patients requiring immediate operation for other injuries
Note, CT A/P with IV contrast NOT sensitive enough for bladder rupture, requires CT cystography
Penetrating Trauma
Any degree of hematuria
Blunt Trauma
Gross hematuria
Hypotension and any degree of hematuria
Child with >50rbc/HPF
High index of suspicion for renal trauma
Deceleration injuries even with no hematuria
Multiple trauma patient
Any degree of hematuria
Gross hematuria
Hypotension and any degree of hematuria
Child with >50rbc/HPF
High index of suspicion for renal trauma
Deceleration injuries even with no hematuria
Multiple trauma patient
Deceleration injuries even with no hematuria
Multiple trauma patient
More sensitive and specific than IVP, ultrasound, or angiography
However, can miss significant injuries to the renal pelvis, collecting system and ureter given CT generally obtained before contrast is excreted in the urine.
If initial CT shows high grade renal injury (grade IV of V), UPJ injury, or concern for ureteral injury, should obtain additional 10 minute delayed CT
Exception to using IVP over CT is perioperatively in unstable patients requiring immediate operation for other injuries
Note, CT A/P with IV contrast NOT sensitive enough for bladder rupture, requires CT cystography
Renal Injuries
Ureter Injuries
Genitourinary trauma
Diaphragmatic trauma
Urethral trauma
Liver trauma
Penile trauma
Splenic trauma
Testicular trauma
Pelvic fractures