Renal Trauma

Kidney is one of the most frequent internal abdominal organ to be injured. Kidney is one of the most frequent internal abdominal organ to be injured. Usually from blunt trauma. Usually from blunt trauma. Presentation is by loin pain and hematuria. Presentation is by loin pain and hematuria. Indication for imaging : depend on clinical features and surgical approach. Indication for imaging : depend on clinical features and surgical approach.

CT is preferred: can show or exclude other organ injury ; CT is preferred: can show or exclude other organ injury ; - demonstrate kidney perfusion. - demonstrate kidney perfusion. - demonstrate the opposite kidney. - demonstrate the opposite kidney. - extend of renal parenchymal damage. - extend of renal parenchymal damage. - demonstrate injuries to other organs specially in penetrating injury. - demonstrate injuries to other organs specially in penetrating injury.

Appearance of the injury Depends on the extent of the injury Depends on the extent of the injury Minor injury ( contusion and small capsular hematoma) : Minor injury ( contusion and small capsular hematoma) : -swelling of the paranchyma and compression of the calices. -swelling of the paranchyma and compression of the calices. -tear : irregular outline and separtion of calyces + subcapsualr and extracapsular hematoma -tear : irregular outline and separtion of calyces + subcapsualr and extracapsular hematoma -extravasation of contrast -extravasation of contrast

- Renal displacement by the hematoma. - Renal displacement by the hematoma. - Fragmentation of the kidney is a serious event …. Nephrectomy or surgical repair - Fragmentation of the kidney is a serious event …. Nephrectomy or surgical repair - rupture or thromboses of renal artery cause absence of nephrogram. - rupture or thromboses of renal artery cause absence of nephrogram.

Hypertension in renal disease Renal disease may account for a hypertension in a small percentrage of patients : Renal disease may account for a hypertension in a small percentrage of patients : - Renal Artery stenosis - Renal Artery stenosis - Chronic glomerulonphritis. - Chronic glomerulonphritis. - Chronic pyelonephritis. - Chronic pyelonephritis. - Polycystic disease. - Polycystic disease. - Polyarteritis nodosa - Polyarteritis nodosa - Diabetic nephroppathy - Diabetic nephroppathy

Renal artery stenosis ; usually from atheroma Renal artery stenosis ; usually from atheroma On US may be suspected if one kidney is smaller than the other. On US may be suspected if one kidney is smaller than the other. Doppler may diagnosis RAS Doppler may diagnosis RAS MR and CT angiography are frequently used. MR and CT angiography are frequently used.

In GN, PAN, and DM there is usually bilateral uniform reduction in renal size without specific features. In GN, PAN, and DM there is usually bilateral uniform reduction in renal size without specific features. Essential hypertension may cause similar change Essential hypertension may cause similar change Search for renal cause is limited to: Search for renal cause is limited to: - children and young adults - children and young adults - severe uncontrolled hypertension - severe uncontrolled hypertension - who have clinical evidence of renal disease - who have clinical evidence of renal disease

Renal Failure Aim of Imaging is to : Aim of Imaging is to : - detect obstruction of the UT - detect obstruction of the UT - determine renal size - determine renal size Bilateral small kidneys suggest chronic, often irreversible renal failure. Bilateral small kidneys suggest chronic, often irreversible renal failure.

Renal failure from obstructive uropathy Cardinal sign is dilatation of PCS. Cardinal sign is dilatation of PCS. Initial investigation is by US. Initial investigation is by US. Demonstration of normal PCS makes an obstructive cause of RT extremely unlikely. Demonstration of normal PCS makes an obstructive cause of RT extremely unlikely.

Renal Failure form intrinsic renal disease ( end-stage-kidney) Chronic reflux nephropathy is the only specific diagnosis that can be made by imaging. Chronic reflux nephropathy is the only specific diagnosis that can be made by imaging. Most end-stage kidneys are small in size with a thin echogenic paranchyma. Smooth outline and normal calyces, as seen in : Most end-stage kidneys are small in size with a thin echogenic paranchyma. Smooth outline and normal calyces, as seen in : - chronic GN. - chronic GN. - DM - DM - hypertensive nephropathy. - hypertensive nephropathy.

Acute Tubular necrosis Normal or enlarged kidneys but with normal PCS. Normal or enlarged kidneys but with normal PCS. Renal paranchyma may be diffusely echogenic. Renal paranchyma may be diffusely echogenic. On IVU dense nephrogram seen for 24 hr without visible PCS On IVU dense nephrogram seen for 24 hr without visible PCS

Congenital anomalies of the urinary tract Frequent Frequent Bifid collecting system : Bifid collecting system : - are most frequent congential variation. - are most frequent congential variation. - may be unilateral or bilateral. - may be unilateral or bilateral. - complete or partial. - complete or partial. - the ureter draining upper moiety may drain outside the bladder Incontinence - the ureter draining upper moiety may drain outside the bladder Incontinence - ectopic ureters usually obstructed may cause ureterocele( filling defect on IVU and intravesical cyst at side of UVJ by US ) - ectopic ureters usually obstructed may cause ureterocele( filling defect on IVU and intravesical cyst at side of UVJ by US )

Ectopic Kidney Kidney ascend from pelvis Kidney ascend from pelvis Ectopic kidney result if the ascend is halted. Ectopic kidney result if the ascend is halted. Usually in lower abdomen and malrotated. Usually in lower abdomen and malrotated. Ureter is usually short and in normal position Ureter is usually short and in normal position Some cases both kidneys in one side ( crossed fused ectopia) Some cases both kidneys in one side ( crossed fused ectopia) Stone, hydronephrosis and chronic pyelonephritis are more common in ectopic kidneys. Stone, hydronephrosis and chronic pyelonephritis are more common in ectopic kidneys. But ususally incidental findings seen on US But ususally incidental findings seen on US

Horseshoe kindey Kidney fail to separate Kidney fail to separate Almost invariably it is the lower pole fused Almost invariably it is the lower pole fused May be incidental finding but PUJ and stone are common. May be incidental finding but PUJ and stone are common.

Inherited cystic disease of the kidneys Vary from Vary from - simple cyst which may be single or multiple. - simple cyst which may be single or multiple. - complex dysplasia : - complex dysplasia : > autosomal dominant poly cystic kidney disease. > autosomal dominant poly cystic kidney disease. - most common - most common - familial - familial - present at 35-55y ( hypertension, RF, Hematuria) - present at 35-55y ( hypertension, RF, Hematuria) - liver and pancreas may also contain cysts - liver and pancreas may also contain cysts - screening at age of 18 y. - screening at age of 18 y.

Renal agenesis Renal agenesis The opposite kidney ( providing it is normal) will show compensatory hypertrophy. The opposite kidney ( providing it is normal) will show compensatory hypertrophy. No renal tissue seen on US and CT, absence of renal arterial flow and function on Radionuclide studies. No renal tissue seen on US and CT, absence of renal arterial flow and function on Radionuclide studies.

PUJ obstruction PUJ obstruction Renal hypoplysia and Dysplasia Renal hypoplysia and Dysplasia

U. Bladder

Well seen in all imaging modalities Well seen in all imaging modalities On US : On US : - uniform wall thickness < 3mm. - uniform wall thickness < 3mm. - echo free lumen. - echo free lumen. - volume can be measured 3 D. - volume can be measured 3 D.

Bladder Tumors Is the most frequent site for neoplasm in UT. Is the most frequent site for neoplasm in UT. Almost all are transitional cell carcinoma. Almost all are transitional cell carcinoma. Different shape (sessile, flat-plaque like, Different shape (sessile, flat-plaque like, fronded papillay ) fronded papillay )

Appearance by imaging US : US : - soft tissue masses protruding into the fluid filled UB. - soft tissue masses protruding into the fluid filled UB. - as a localized bladder wall thickening. - as a localized bladder wall thickening. - US is poor for detecting extravesical spread. - US is poor for detecting extravesical spread.

IVU : IVU : - if large, appear as a filling defect. - if large, appear as a filling defect. - rarely surface calcification of the tumor seen - rarely surface calcification of the tumor seen - main role is demonstrate any other lesions - main role is demonstrate any other lesions in the upper tract (PCS and ureter). in the upper tract (PCS and ureter). Nature and extend is best by cystoscopy. Nature and extend is best by cystoscopy.

CT and MRI : CT and MRI : - soft tissue masses protruding into the fluid - soft tissue masses protruding into the fluid filled UB. filled UB. - as a localized bladder wall thickening. - as a localized bladder wall thickening. - there role is to stage the tumor. - there role is to stage the tumor. - determine spread of the tumor beyond - determine spread of the tumor beyond the bladder wall. the bladder wall. - assess Lymphnode involvement. - assess Lymphnode involvement.

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