Paediatric Imaging

Renal pedicle injury

With severe renal trauma the vascular supply to the kidney can be interrupted with or without renal parenchymal damage. It is important to recognize this as, without re-establishing the circulatory continuity, the kidney will atrophy completely. It is more common for the artery to be disrupted than the vein. Arterial injury includes transection or more rarely subintimal dissection. When there is disruption there is often associated injury to the renal pelvis with leakage of urine, and there is the development of a urinoma in addition to haemorrhage. The vascular compromise can be recognized on ultrasound using Doppler or colour flow Doppler by determining that there is no flow to the kidney or part of the kidney. The lesion is also identified on CT if part or all of the kidney fails to take up the injected intra venous contrast medium (Fig.1). See renal artery occlusion and renal trauma

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Fig.1

CT scan in a boy following a road traffic accident. The left kidney is devascularised and shows no nephrogram. There is a small amount of fluid around the right kidney. This boy also has splenic trauma.
Renal pedicle injury, Fig.1