ahmed fahmyscase-study by alphauro


									Case study
Unit B

A 15-year-old male patient developed flank pain immediately after a direct blow to his left flank during football playing. Urinalysis revealed no hematuria. Clinically: mild flank tenderness , no echymosis V/S: vitally stable.

U/S: demonstrates perinephric fluid collection around the Lt kidney

Contrast-enhanced CT scan shows laceration through thinned parenchyma of lower left kidney. Excreted contrast agent settles dependently into dilated calyces with urinoma anterior to kidney.

Contrast-enhanced • CT scan at mid kidney shows slightly collapsed but intact left renal pelvis, large urinoma displacing

intestines to the right.

Rupture of Lt HN kidney (grade IV injury)

Abdominal exploration showed a ruptured left hydronephrotic kidney with a large urinoma . HN appeared to be due to ureteropelvic junction obstruction with an intact dilated renal pelvis. DJ insertion with repair of lacerated parenchyma was performed. Patient is awaiting for elective ureteropelvic junction repair after radionucleatide scintigraphy.

KUB: showing Lt DJ stent inserted intraoperatively

Contrast-enhanced CT scan obtained 7 days after placement of ureteral stent (arrow) shows resolution of urinoma, increased contrast excretion compared with A, and
no extravasation.

Points to remember
Renal injury caused by blunt abdominal trauma is approximately twice as common in children as adults as they have relatively larger kidneys, less perinephric fat & decreased muscule and bony protection. A preexisting renal abnormality increases the risk for blunt renal injury. The degree of hematuria does not correlate with the grade of renal injury.

Points to remember
CT is the appropriate radiologic examination in patients with blunt renal injury and should always include a nephrographic phase.

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