IMAGING EVALUATION OF BLUNT RENAL TRAUMA IN CHILDREN - DIAGNOSTIC-ACCURACY OF INTRAVENOUS PYELOGRAPHY AND ULTRASONOGRAPHY

Forty-six consecutive children with blunt renal injury were evaluated retrospectively to assess the diagnostic accuracy of the different ima ging methods, including ultrasonography (US), intravenous pyelography (IVP), and computed tomography (CT), and to determine the optimal radi ologic management. Doppler ultrasonography was never performed in an e mergency. Classification of the 46 renal injuries was as follows: 25 c ontusions, 4 lacerations, 11 ruptures, and 6 pedicle injuries. The dia gnostic accuracy of IVP (80.8%) was superior to the diagnostic accurac y of US (41%) in all types of renal injuries. IVP should be performed as an emergency procedure when macroscopic hematuria is present, or wh en an isolated renal injury is clinically suspected. Microscopic hemat uria alone is no longer an indication to perform IVP. Asymptomatic pat ients with microscopic hematuria should have US examination and should be observed with performance of serial urine analyses. Multiply injur ed and hemodynamically stable children should be evaluated by contrast -enhanced CT, Hemodynamically unstable children should undergo immedia te exploratory laparotomy, if it is indicated after assessment by imag ing.