Imaging Criteria for Radiographic Assessment in Adults

Decisions about radiographic imaging in cases of suspected renal trauma are based on the clinical findings and the mechanism of injury. Since the majority of renal injuries are not significant and resolve without any intervention, many attempts have been made to identify patients who could be spared the discomfort, radiation exposure, possible allergic reaction, and expense of a radiographic evaluation (Miller and McAninch 1995).

There is mounting evidence that following blunt renal trauma, some patients do not require radiographic evaluation. Patients with microscopic hematuria and no shock after blunt trauma have a low likelihood of concealing significant renal injury (Hardeman and Hus-mann 1987). The indications for radiographic evaluation are gross hematuria, microscopic hematuria and shock, or presence of major associated injuries (Miller and McAninch 1995; McAndrew and Corriere 1994). However, patients with a history of rapid deceleration injury with clinical indicators of renal trauma or associated injuries also need immediate imaging to rule out ureteral avulsion or renal pedicle injury (Brandes et al. 1999a).

Patients with penetrating trauma to the torso have a high incidence of significant renal injuries. If renal injury is clinically suspected on the basis of an entry or exit wound, renal imaging should be performed, regardless of the degree of hematuria (Miller and McAninch 1995; Mee and McAninch 1989).

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