Imaging assessment of renal injuries in children and adolescents: CT or ultrasound?
BACKGROUND
Since the introduction of the ALARA ("as low as reasonably achievable") concept, ultrasound (US) has been progressively advocated for paediatric diagnostic imaging. This study aimed to analyse the role and accuracy of US in paediatric renal trauma.


METHODS
From 1999 to 2009, the tertiary-care-hospital database was retrospectively evaluated for renal trauma with regards to aetiology, type of injury, diagnostics, management and outcome.


RESULTS
Forty-seven patients (29 males, 18 females; median age=14years, range 1-17 years) were identified. US was initially applied in 45 patients with correct results in 86.6%. Computed tomography (CT) was performed in 16 patients in the acute trauma setting - complementary to US in 14 cases, with a diagnostic accuracy of 93%. Most renal injuries were grade I° (n=30), followed by grade III° (n=8), IV° (n=5), and II°/V° (n=2 each). All patients were initially managed conservatively and followed by US. Clinical deterioration necessitated surgery in four patients (2 nephrectomies, 1 partial nephrectomy, 1 urinoma drainage). The outcome was generally favourable with a renal preservation rate of 95%.


CONCLUSIONS
With respect to the ALARA principle, US can be safely and reliably applied as the first-line diagnostic imaging technique and for follow-up for suspected traumatic paediatric renal injuries.
Department for Paediatric and Adolescent Surgery, Medical University of Graz, Austria.
Eva Elisa
EE
Amerstorfer
Department for Paediatric and Adolescent Surgery, Medical University of Graz, Austria. Electronic address: axel.haberlik@medunigraz.at.
Axel
A
Haberlik
Department for Radiology, Division of Paediatric Radiology, Medical University of Graz, Austria.
Michael
M
Riccabona
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D009392:Nephrectomy; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D053584:Urinoma / Q000628:therapy
ALARA; Children and adolescents; Diagnostics; Management; Renal injury; Ultrasound