How to Do a CT in a Patient with Presumed Upper Tract Trauma
Patients with significant blunt trauma and macroscopic hematuria should be considered for urgent CT as are those with significant penetrating trauma. Patients with microscopic hematuria following minor blunt trauma are very unlikely to have significant urological injury and are therefore not routinely imaged by CT scanning unless there is another additional indication (such as cardiovascular instability). Ultrasound would be more usual in the “uncomplicated microscopic hematuria.” Patients that are difficult to assess clinically such as the intoxicated patient, the mentally ill patient or the obese patient and patients with penetrating injuries may require prompt CT in the absence of macroscopic hematuria (Fig. 13.1).