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"Contrast enhanced CT is the primary imaging technique used to evaluate the upper and lower urinary tract for traume. Cystography and urethrography remain useful techniques in the initial evaluation and follow-up of trauma to the urinary bladder and urethra."
Imaging of the Genitourinary Tract
Ramchandani P et al.
AJR 2009; 192:1514-1523- When to order a CT in cases of trauma for the kidneys?
- Penetrating trauma and hematuria
- Blunt trauma, shock and hamaturia
- Gross hematuria
- Kidney in Danger:CT Findings of Blunt and Penetrating Renal Trauma Alonso RC et al. RadioGraphics 2009; 29:2033-2053 - AAST Renal Injury Scale
Grade of InjuryType of InjuryI Normal contusion or small hematomaII Hematoma or <1cm lacerationIII Laceration >1cmIV Laceration (deep) or vascular injuryV Laceration (shattered kidney) or vascular injury (avulsion) - AAST Renal Injury Scale: Grade I
- Normal contusion- microscopic or gross hematuria with normal urologic findings
- Hematoma- nonexpanding subcapsular hematomas with no laceration - AAST Renal Injury Scale: Grade II
- Hematoma- nonexpanding perinephric hematoma confined to the retroperitoneum
- Laceration- superficial cortical laceration less than 1 cm without collecting system injury - AAST Renal Injury Scale: Grade III
- Laceration- renal lacerations greater than 1 cm in depth without collecting system injury - AAST Renal Injury Scale: Grade IV
- Laceration- renal lacerations extending through the renal cortex, medulla, and collecting system
- Vascular injury- injuries involving the main renal artery or vein with contained hematoma, segmental infarctions without associated lacerations - AAST Renal Injury Scale: Grade V
- Laceration- shattered kidney, UPJ avulsions
- Vascular injury- complete laceration (avulsion) or thrombosis of the main renal artery or vein that devascularizes the kidney - Renal Trauma: AAST Grading System
- Based on surgical findings
- Useful tool to predict outcomes
- The 5 categories “arranged in order of increasing severity according to depth of injury and involvement of the vasculature or collecting system, and correlates well with any abnormalities seen on CT "The increased use of CT has been partially responsible for a growing trend toward conservative management of renal trauma, except in cases in which extensive urinary extravasation or devitalized areas of renal parenchyma are found and especially in those cases with associated injuries to other abdominal organs."
Kidney in Danger: CT Findings of Blunt and Penetrating Renal Trauma
Alonso RC et al.
RadioGraphics 2009; 29:2033-2053- Bladder Trauma: Facts
- 80% of patients with bladder injuries due to blunt trauma have pelvic fractures
- Approximately 30% of patients with pelvic fractures have bladder injury
- The dome is most commonly injured with trauma as it is the weakest part of the bladder
- Intraperitoneal injuries are about one third of bladder injuries and extraperitoneal about two thirds - Bladder Trauma: Categories
- Bladder contusion
- Intraperitoneal rupture
- Extraperitoneal rupture
- Combined injury "Contrast enhanced CT is the primary imaging technique used to evaluate the upper and lower urinary tract for traume. Cystography and urethrography remain useful techniques in the initial evaluation and follow-up of trauma to the urinary bladder and urethra."
Imaging of the Genitourinary Tract
Ramchandani P et al.
AJR 2009; 192:1514-1523