Abstract
ObjectivesTo show the wide spectrum of computed tomography (CT) findings in blunt renal trauma and to correlate them with consequent therapeutic implications.MethodsThis article is the result of a literature review and our personal experience in a level II trauma centre. Here we describe, discuss and illustrate the possible CT findings in blunt renal trauma, and we correlate them with the American Association for the Surgery of Trauma (AAST) classification and their therapeutic implications.ResultsCT findings following blunt renal trauma can be grouped into 15 main categories, 12 of them directly correlated with the AAST classification and 3 of them not mentioned in it. Non-operative management, which includes the “watchful waiting” approach, endourological treatments and endovascular treatments, is nowadays widely adopted in blunt renal trauma, and surgery is limited to haemodynamically unstable patients and a minority of haemodynamically stable patients.ConclusionsThe interpretation of CT findings in blunt renal trauma may be improved and made faster by the knowledge of their therapeutic consequences.Teaching Points• The majority of blunt renal injuries do not require surgical treatment.• CT findings in blunt renal injury must be evaluated considering their therapeutic consequences.• Some CT findings in blunt renal trauma are not included in the AAST classification.
Highlights
Renal injuries represent a relatively common event, involving 8–10 % of the patients admitted to an emergency department because of abdominal trauma, and the incidence is increasing parallel to the increase in motor-vehicle accidents [1,2,3,4]
Some computed tomography (CT) findings in blunt renal trauma are not included in the Association for the Surgery of Trauma (AAST) classification
Gross haematuria is the typical presenting symptom of renal injury, it may be absent in about 5 % of renal injuries, and its presence is not directly correlated with injury severity: for example, haematuria is typically absent in vascular pedicle injuries and ureteral-pelvic injuries [11, 12]
Summary
Renal injuries represent a relatively common event, involving 8–10 % of the patients admitted to an emergency department because of abdominal trauma, and the incidence is increasing parallel to the increase in motor-vehicle accidents [1,2,3,4]. Renal trauma may occur in isolation or in association. According to the American Association for the Surgery of Trauma (AAST), on the basis of surgical findings renal injuries can be subdivided into five main categories (Table 1), with a progressively poorer prognosis [13]. Renal exploration remains mandatory in every case of haemodynamic instability following renal trauma and if a pulsatile or expanding retroperitoneal haematoma is identified during exploratory laparotomy performed for other abdominal injuries
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