CT images of blunt renal trauma: Correlating the degree of hematuria, CT classification, treatment and outcome

The aim of this study is to correlate the degree of hematuria, grade in CT classification, treatment and outcome in patients with blunt renal trauma. Ninety patients (72 men and 18 women) with blunt renal trauma presenting flank pain and hematuria received contrast-enhanced CT study within 12 hours after trauma. According to the CT appearance, blunt renal trauma was further classified into four grades. Results were compared to the surgical findings and clinical follow-up. There were 63 cases with grade I renal lesions, nine grade II, 15 grade III and three grade IV. Seventy-eight of 90 cases (86.7%) required conservative treatment only, three (3.3%) received renorrhaphy and six (6.7%) underwent nephrectomy. One (1.1%) with perirenal hematoma complicated by perirenal abscess required percutaneous drainage. One (1.1%) with a grade I renal lesion expired due to hypovolemic shock after multiple fractures of the pelvis and the femur. Another one (1.1%) with a grade III lesion expired due to active renal arterial hemorrhage. The motality rate in patients with blunt renal trauma was 2.2% (2/90). Two cases of major vascular pedicle injury presented microscopic hematuria only. Althrough the presence of microscopic hematuria may suggest mild blunt renal trauma in most cases, patients with vascular pedical injury may present with microscopic hematuria only. Contrast-enhanced CT is capable of demonstrating the severity of blunt renal trauma. The CT findings associated with clinical evaluation on patient's hemodynamic status may provide important information for surgical treatment planning. In our study, the overall prognosis of blunt renal trauma is generally good.