Ultrasound, CT (Renal Trauma)

hage_34a_n.jpg: Ultrasound of a 4-year-old boy with suspicion of trauma to the left kidney. Longitudinal slice perpendicular to the renal surface in which there is a zone of multiple focuses with ultrasound echos. This zone separates a smaller superior part of the kidney from a larger inferior part. Figure hage_34b_n.jpg and hage_34c_n.jpg: In the CT with intravenous contrast hyperdense fields in projection to the left kidney are visible; between and around them a large hypodense mass is recognizable ( hage_34b_n.jpg). In a more cranially situated slice the kidney is recognizable by its typical structure; it contains a dorsal hyperdense part and medially of the normal spleen a hypodense part with fine delineation. There is no major contrast extravasation ( hage_34c_n.jpg). hage_34d_n.jpg: Ultrasound 1.6 year after the injury. In contrast to the normal inferior part of the kidney the superior part is much smaller without any recognizable elements of the pelvicocaliceal system. hage_34a_n.jpg to hage_34d_n.jpg: This boy had a grade 3 (III) renal rupture which was treated by non-operative measures; the smaller superior part of the kidney became hypoplastic while the residual kidney underwent a normal development. This case illustrates the significance of the two work-up examinations ultrasound and CT. In case of a moderate and severe renal trauma, ultrasound is insufficient for staging of severity and for a possible indication to surgery, and a CT must be performed. In critical situations or polytrauma it is better to immediately perform a CT; on that occasion combined injuries (as in the case report an injury of the spleen) can be safely excluded.