Imaging of Renal Trauma(PDF 18)英文

Imaging of Renal
Trauma: A Comprehensive
Review1
LEARNING
OBJECTIVES
FOR TEST 1
After reading this
article and taking
the test, the reader
will be able to:
Describe the spectrum
of posttraumatic
renal injuries.
Identify the key
imaging features of
trauma-related renal
injury.
Correlate the clinical
and imaging findings
in renal trauma.
Akira Kawashima, MD ● Carl M. Sandler, MD ● Frank M. Corl, MS
O. Clark West, MD ● Eric P. Tamm, MD ● Elliot K. Fishman, MD
Stanford M. Goldman, MD
Computed tomography (CT) is the modality of choice in the evaluation
of blunt renal injury. Intravenous urography is used primarily for
gross assessment of renal function in hemodynamically unstable patients.
Selective renal arteriography or venography can provide detailed
information regarding vascular injury. Retrograde pyelography is valuable
in assessing ureteral and renal pelvic integrity in suspected ureteropelvic
junction injury. Ultrasonography is useful in detecting hemoperitoneum
in patients with suspected intraperitoneal injury but has
limited value in evaluating those with suspected extraperitoneal injury.
Occasionally, radionuclide renal scintigraphy or magnetic resonance
imaging may prove helpful. Renal injuries can be classified into four
large categories based on imaging findings. Category I renal injuries
include minor cortical contusion, subcapsular hematoma, minor laceration
with limited perinephric hematoma, and small cortical infarct.
Category II lesions include major renal lacerations extending to the
medulla with or without involvement of the collecting system and segmental
renal infarct. Category III lesions are catastrophic renal injuries
and include multiple renal lacerations and vascular injury involving the
renal pedicle. Category IV injuries are ureteropelvic junction injuries.
CT is particularly useful in evaluating traumatic injuries to kidneys
with preexisting abnormalities and can help assess the extent of penetrating
injuries in selected patients with limited posterior stab wounds.
Integration of the imaging findings in renal injury with clinical information
is critical in developing a treatment plan.
Index terms: Kidney, CT, 81.1211 ● Kidney, infarction, 81.77 ● Kidney, injuries, 81.41, 81.77 ● Renal angiography, 81.124 ● Renal arteries, injuries,
961.41 ● Trauma, 81.40
RadioGraphics 2001; 21:557–574
1From the Departments of Radiology (A.K., C.M.S., O.C.W., E.P.T., S.M.G.) and Urology (C.M.S., S.M.G.), University of Texas-Houston Medical
School, Houston, Tex; the Department of Radiology, Memorial Hermann Hospital, Houston, Tex (A.K., C.M.S., O.C.W., E.P.T., S.M.G.); the Department
of Radiology, Lyndon B. Johnson General Hospital, Houston, Tex (A.K., C.M.S., E.P.T.); and the Russell H. Morgan Department of Radiology and
Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Md (F.M.C., E.K.F.). Recipient of a Certificate of Merit award for a scientific exhibit
at the 1999 RSNA scientific assembly. Received June 20, 2000; revision requested July 13 and received August 21; accepted August 22. Address correspondence
to A.K., Department of Radiology, Mayo Clinic, 200 First St SW, Rochester,MN55905 (e-mail: kawashima.akira@mayo.edu).
?RSNA, 2001
CME FEATURE
See accompanying
test at http://
www.rsna.org
/education
/rg_cme.html
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