Multimedia
 | Media file 1: Kidney trauma. One-shot intravenous pyelogram, normal. Ten-minute radiograph taken after intravenous contrast administration on a patient with a stab wound to the back shows normal kidneys and ureters bilaterally. |
 | Media file 2: Kidney trauma. Grade 3 renal laceration with normal one-shot intravenous pyelogram. CT scan through the kidneys after intravenous contrast on the same patient as in Image 1 shows renal laceration and perinephric hematoma. |
 | Media file 3: Kidney trauma. Absent nephrogram. Abdominal radiograph after intravenous contrast administration in a patient with hypotension after a motor vehicle collision shows absent right nephrogram. |
 | Media file 4: Kidney trauma. Normal ultrasound with grade 5 renal injury. Ultrasound gray-scale image of a patient involved in a motor vehicle collision shows what appears to be a normal right kidney. |
 | Media file 5: Kidney trauma. Grade 5 renal injury. Color Doppler ultrasound of same motor vehicle collision patient as in Image 4 shows no blood flow within the right kidney. |
 | Media file 6: Kidney trauma. Grade 5 renal injury. CT of the abdomen with intravenous and oral contrast on same patient as in Image 5 shows nonenhancement of the right kidney. Note relatively small amount of perinephric or intraperitoneal hemorrhage. |
 | Media file 7: Kidney trauma. Grade 4 renal injury. Sonogram in an 8-year-old child with posttraumatic renal infarction shows both kidneys with an avascular area in the lower half of the affected kidney. Courtesy of Durre Sabih, MBBS. |
 | Media file 8: Kidney trauma. Grade 4 renal injury. Sonogram of the same patient as in Image 7 shows progressive shrinkage of the lower half as the kidney goes ischemic autopartial nephrectomy. Courtesy of Durre Sabih, MBBS. |
 | Media file 9: Kidney trauma. Grade 4 renal injury. Sonogram of the same patient as in Image 8 shows progressive shrinkage of the lower half as the kidney goes ischemic autopartial nephrectomy. Courtesy of Durre Sabih, MBBS. |
 | Media file 10: Kidney trauma. Grade 1 renal injury, contusion. Image from a contrast-enhanced CT scan of the abdomen in a patient with hematuria after a motor vehicle collision shows ill-defined area of hypoenhancement in the medial right kidney. |
 | Media file 11: Kidney trauma. Grade 1 renal injury, subcapsular hematoma. CT scan of the abdomen with intravenous contrast in a patient after a motor vehicle collision shows crescentic high-density fluid collection around the left kidney. Note the well-defined outer margin. |
 | Media file 12: Kidney trauma. Grade 1 renal injury, subcapsular hematoma. CT scan of the abdomen with intravenous contrast in a patient after a motor vehicle collision; same patient as in Image 11 shows crescentic high-density fluid collection around the left kidney. Note the well-defined outer margin and the mild deformity of the renal parenchyma. |
 | Media file 13: Kidney trauma. Grade 2 renal injury, subcapsular and perinephric hematomas. Contrast-enhanced CT scan of the abdomen on a patient with hematuria after a motor vehicle collision shows an ill-defined fluid collection in the left perinephric space. There is also a subcapsular hematoma with deformity of the renal parenchyma. |
 | Media file 14: Kidney trauma. Grade 2 renal injury, perinephric hematoma. Contrast-enhanced CT scan of the abdomen on a patient with hematuria after a motor vehicle collision shows an ill-defined fluid collection in the left perinephric space. |
 | Media file 15: Kidney trauma. Grade 2 renal laceration. Contrast-enhanced CT scan of the abdomen after a motor vehicle collision shows a superficial (less than 1 cm deep) renal parenchymal defect with a large perinephric hematoma. Delayed image (Image 16) shows no urinary contrast extravasation. |
 | Media file 17: Kidney trauma. Grade 3 renal laceration on abdominal radiograph. Abdominal radiograph after intravenous contrast administration shows very diminished left nephrogram and no urinary contrast extravasation. |
 | Media file 18: Kidney trauma. Grade 3 renal laceration. CT scan of the abdomen after intravenous contrast administration shows irregular nonenhancing renal parenchymal defect with extension greater than 1 cm deep to near the renal pelvis. Delayed image (Image 19) showed no urinary contrast extravasation. |
 | Media file 19: Kidney trauma. Grade 3 renal laceration. CT scan of the abdomen after intravenous contrast administration shows irregular nonenhancing renal parenchymal defect with extension greater than 1 cm deep to near the renal pelvis (Image 18). This delayed image showed no urinary contrast extravasation. |
 | Media file 20: Kidney trauma. Grade 4 renal injury segmental infarction. Contrast-enhanced CT scan of the upper abdomen shows a segmental area of nonenhancement in the upper medial left kidney without associated renal laceration. |
 | Media file 21: Kidney trauma. Grade 4 renal injury segmental infarction. Contrast-enhanced CT scan of the upper abdomen in another patient after a motor vehicle collision shows a segmental area of nonenhancement in the upper medial left kidney without associated renal laceration. |
 | Media file 22: Kidney trauma. Grade 4-5 renal injury. Lacerations extending to the collecting system. Contrast-enhanced CT scan of the abdomen in a patient with hematuria after a motor vehicle collision shows deep lacerations extending into the collecting system of the right kidney. Extension into the collecting system is confirmed by urinary contrast extravasation on delayed image through the kidney in excretory phase (Image 23). |
 | Media file 23: Kidney trauma. Grade 4-5 renal injury. Lacerations extending to the collecting system. Contrast-enhanced CT scan of the abdomen in a patient with hematuria after a motor vehicle collision shows deep lacerations extending into the collecting system of the right kidney (Image 22). Extension into the collecting system is confirmed by urinary contrast extravasation on this delayed image through the kidney in excretory phase. |
 | Media file 24: Kidney trauma. Grade 5 renal injury. Shattered left kidney. Contrast-enhanced CT scan of the abdomen in a patient with hematuria after a motor vehicle collision shows several deep lacerations extending into the collecting system of the left kidney with separation of the fragments. |
 | Media file 25: Kidney trauma. Grade 5 renal injury. Ureteropelvic junction avulsion. Contrast-enhanced CT scan of the abdomen in a patient involved in a motor vehicle collision shows fairly normal appearing right kidney with perinephric fluid extending into the renal hilum. Delayed image (Image 26) shows urinary contrast extravasation. |
 | Media file 26: Kidney trauma. Grade 5 renal injury. Ureteropelvic junction avulsion. Contrast-enhanced CT scan of the abdomen in a patient involved in a motor vehicle collision shows fairly normal appearing right kidney with perinephric fluid extending into the renal hilum (Image 25). This delayed image shows urinary contrast extravasation. |
 | Media file 27: Kidney trauma. Grade 5 renal injury. Partial ureteropelvic junction tear and multiple deep lacerations. Contrast-enhanced CT scan of the abdomen in a patient involved in a motor vehicle collision shows multiple deep renal lacerations with perinephric fluid extending into the renal hilum. Delayed image (Image 28) shows urinary contrast extravasation. A follow-up exam (Image 29) shows development of a urinoma, in spite of initial treatment with stent placement. |
 | Media file 28: Kidney trauma. Grade 5 renal injury. Partial ureteropelvic junction tear and multiple deep lacerations. Contrast-enhanced CT scan of the abdomen in a patient involved in a motor vehicle collision shows multiple deep renal lacerations with perinephric fluid extending into the renal hilum (Image 27). This delayed image shows urinary contrast extravasation. A follow-up exam (Image 29) shows development of a urinoma, in spite of initial treatment with stent placement. |
 | Media file 29: Kidney trauma. Grade 5 renal injury. Partial ureteropelvic junction tear and multiple deep lacerations. Contrast-enhanced CT scan of the abdomen in a patient involved in a motor vehicle collision shows multiple deep renal lacerations with perinephric fluid extending into the renal hilum (Image 27). Delayed image show urinary contrast extravasation (Image 28). A follow-up exam shows development of a urinoma, in spite of initial treatment with stent placement. |
 | Media file 30: Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-enhanced CT scan of the abdomen in a patient with hematuria and hypotension after a motor vehicle collision shows transection of the right kidney with a large hematoma around and between the 2 halves of the kidney. The 2 halves are both perfused because there were 2 renal arteries (this image and Image 31). Delayed images show urinary contrast extravasation (Images 32 and 33). |
 | Media file 31: Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-enhanced CT scan of the abdomen in a patient with hematuria and hypotension after a motor vehicle collision shows transection of the right kidney with a large hematoma around and between the 2 halves of the kidney. The 2 halves are both perfused because there were 2 renal arteries (this image and Image 30). Delayed images show urinary contrast extravasation (Images 32 and 33). |
 | Media file 32: Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-enhanced CT scan of the abdomen in a patient with hematuria and hypotension after a motor vehicle collision shows transection of the right kidney with a large hematoma around and between the 2 halves of the kidney. The 2 halves are both perfused because there were 2 renal arteries (Images 30 and 31). Delayed images show urinary contrast extravasation (this image and Image 33). |
 | Media file 33: Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-enhanced CT scan of the abdomen in a patient with hematuria and hypotension after a motor vehicle collision shows transection of the right kidney with a large hematoma around and between the 2 halves of the kidney. The 2 halves are both perfused because there were 2 renal arteries (Images 30 and 31). Delayed images show urinary contrast extravasation (this image and Image 32). |
 | Media file 34: Kidney trauma. Grade 5 renal injury. Shattered kidney with renal vein thrombosis (incomplete). Abdominal radiograph after intravenous contrast administration shows absent right nephrogram. CT scan (Image 35) shows shattered kidney and renal vein thrombus extending slightly into the inferior vena cava. |
 | Media file 35: Kidney trauma. Grade 5 renal injury. Shattered kidney with renal vein thrombosis (incomplete). CT scan of the abdomen with intravenous contrast administration of same patient as in Image 34 shows shattered right kidney and renal vein thrombus extending slightly into the inferior vena cava. |
 | Media file 36: Kidney trauma. Grade 5 renal injury, devascularization. Contrast-enhanced CT scan of the abdomen in a 52-year-old man after an assault shows dissection of the origin of the left renal artery, with no perfusion of the left kidney. Also, a hematoma can be noted along the anterior renal fascia. |
 | Media file 37: Kidney trauma. Grade 5 renal injury, devascularization. Contrast-enhanced CT scan of the abdomen in a 52-year-old man after an assault (same patient as in Image 36), with dissection of the origin of the left renal artery, no perfusion of the left kidney, and a hematoma along the anterior renal fascia. Four-week follow-up shows no change, ie, no trace of renal cortical rim enhancement. An adjacent cystic hematoma along the anterior renal fascia persists. |
 | Media file 38: Kidney trauma. Active vascular contrast extravasation. A male of unknown age after a motor vehicle collision with hematuria and hypotension. CT scan of the abdomen with contrast shows a small upper pole laceration on the left with large perinephric hematoma and a tiny "flame" of intravenous contrast extravasation. Lower image (Image 39) shows a small "pool" of layering contrast extravasated into the hematoma. |
 | Media file 39: Kidney trauma. Active vascular contrast extravasation. A male of unknown age after a motor vehicle collision with hematuria and hypotension. CT scan of the abdomen with contrast shows a small upper pole laceration on the left with large perinephric hematoma and a tiny "flame" of intravenous contrast extravasation (Image 38). This lower image shows a small "pool" of layering contrast extravasated into the hematoma. |
 | Media file 40: Kidney trauma. Active vascular contrast extravasation. A 35-year-old man presented with hypotension and hematuria following a motor vehicle accident. This contrast-enhanced CT scan shows a perinephric hematoma with central high attenuation, which probably represents active bleeding. Courtesy of Dushyant Sahani, MD. |
 | Media file 41: Kidney trauma. Active vascular contrast extravasation. Catheter angiography during arterial phase on the same patient as in Image 40 shows a small pseudoaneurysm at the lower pole. Courtesy of Dushyant Sahani, MD. |
 | Media file 42: Kidney trauma. Active vascular contrast extravasation. Catheter angiography during nephrographic phase in the same patient as in Image 41 shows a small pseudoaneurysm at the lower pole. Courtesy of Dushyant Sahani, MD. |
 | Media file 43: Kidney trauma. Active vascular contrast extravasation. Pseudoaneurysm at the lower pole in the same patient as in Image 42 was embolized by using a coil. Courtesy of Dushyant Sahani, MD. |
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Further Reading
Keywords
kidney injury, renal trauma, renal injury, genitourinary trauma, blunt abdominal trauma, penetrating abdominal trauma, urinary tract, pelvic injury, renal laceration, renal contusion, renal vascular trauma, hematuria, perinephric hematomas, subcapsular hematomas, ureteropelvic junction, collecting system, renal segmental infarctions, hypovolemic shock
