CT of severe renal trauma in children: evaluation and course of healing with conservative therapy.
Over a 2-year period, blunt renal injuries were classified on a four-point scale: grade 1, contusions; grade 2, tears limited to the cortex (renal lacerations); grade 3, tears extending to the collecting system (renal fractures); and grade 4, renal vascular pedicle injuries. We report our findings in nine children with grade 2 and grade 3 blunt renal injuries who were evaluated with CT. One patient had a nephrectomy; the other eight were managed nonsurgically. Six patients had follow-up CT scans 5-19 months later to assess healing. Scars were evident in each case, and the extent of deformity paralleled the magnitude of the initial injury. One patient with a grade 2 injury and two patients with grade 3 injuries healed with small focal scars; three patients with grade 3 injuries healed with large polar scars. In five patients, the CT findings were compared with the findings on 99mTc-DTPA renal imaging. The injured kidneys contributed 30-45% (mean, 38%) of total renal function. In six patients with renal trauma who were treated conservatively, the involved kidneys healed and significant kidney function was preserved, although early surgical intervention might have been beneficial for one of these patients. Prospective studies are needed to evaluate further the effectiveness of this conservative approach.
Yale-Loehr
A J
AJ
Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Kramer
S S
SS
Quinlan
D M
DM
La France
N D
ND
Mitchell
S E
SE
Gearhart
J P
JP
D002648:Child; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D009942:Organometallic Compounds; D004369:Pentetic Acid; D011877:Radionuclide Imaging; D004113:Succimer; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D016284:Technetium Tc 99m Pentetate; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000000981:diagnostic imaging* / Q000628:therapy
D009942:Organometallic Compounds; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D004369:Pentetic Acid; D004113:Succimer; D016284:Technetium Tc 99m Pentetate