title: Multislice CT-angiography in percutaneous postinterventional hematuria and kidney bleeding: Influence of diagnostic outcome on therapeutic patient management. Preliminary results.
abstract: BACKGROUND
  The aims of this study were to assess the value of multislice CT-angiography (MS-CT-A) in percutaneous postinterventional kidney bleeding and to determine the influence of diagnostic outcome on therapeutic patient management. A recommendation for the interdisciplinary patient work-up for the emergency room was offered.
  
  
  METHODS
  Between April 2003 and January 2006, 12 patients with hematuria and clinically suspected renal bleeding underwent MS-CT-A for emergency diagnostic assessment. The spectrum of kidney injuries on CT was analyzed according to an organ-scaling scheme. The efficacy of MS-CT-A with regard to confirmation of active arterial bleeding was evaluated as well as the therapeutic consequences for patient management.
  
  
  RESULTS
  In seven patients (59%) staged grade V renal injury, active renal arterial bleeding was detected on CT-A. Patients immediately underwent therapeutic angiography with confirmation of arterial bleeding and successful embolization. Four patients (33%) were staged grade I renal injury with subcapsular kidney hematoma but no active hemorrhage. Therefore, these patients were not exposed to further therapeutic intervention. One patient (8%) was diagnosed grade II renal injury with superficial cortical renal parenchyma tear and no active bleeding on CT-A.
  
  
  CONCLUSIONS
  MS-CT-A is a valuable, fast and objective emergency tool for assessment of postinterventional renal hemorrhage. Detection of contrast material extravasation to affirm ongoing arterial bleeding and to localize bleeding site at the level of segmental or interlobar renal artery is a predictor for the need for further treatment and justifies therapeutic radiological or surgical management.
authors.affiliation: Institute of Clinical Radiology, University Hospital Manheim, Faculty for Clinical Medicine of the University of Heidelberg, Mannheim, Gemany. maliha.sadick@rad.ma.uni-heidelberg.de
authors.forename: Maliha
authors.initials: M
authors.lastname: Sadick
authors.forename: Boris
authors.initials: B
authors.lastname: Röhrl
authors.forename: Peter
authors.initials: P
authors.lastname: Schnülle
authors.forename: Christoph
authors.initials: C
authors.lastname: Düber
authors.forename: Steffen J
authors.initials: SJ
authors.lastname: Diehl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D004621:Embolization, Therapeutic; D005260:Female; D006417:Hematuria / Q000175:diagnosis / Q000628:therapy; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000293:injuries; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000293:injuries; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome