Radiologic Management of Adult Traumatic Renal and Pelvic Hemorrhage

Abstract

To evaluate a blunt renal trauma we have nowadays the following diagnostic methods: (a) plain film of the urogenital tract, (b) excretory urography with zonography, (c) sonography, (d) CT, and (e) angiography. We demand from all these procedures that they can be performed rapidly, do not harm to the patient, and permit a precise and unmistakable statement about the injury and its extent, thus leading to the appropriate therapy. In blunt renal trauma we can distinguish acute direct lesions from late traumatic lesions. The classification of the blunt renal trauma according to Hodges [1] is commonly accepted (Table 1). The diagnostic sequence generally followed is shown in Fig. 1. The sequence must be modified, however, with regard to interventional therapy. Angiography is then carried out before sonography and CT, immediately after urography, or immediately after CT. A decision to this effect will be made in the presence of massive life threatening hematuria, since as much renal parenchyma as possible should be preserved.