Use of ultrasonography in the patient with acute renal trauma

The purpose of this study was to assess the use of emergent ultrasonographi c examination in acute traumatic renal injuries. Over a 3 year period, pros pective data of all patients who had an emergency ultrasonogram were record ed. Thirty-two patients with 37 renal injuries were studied retrospectively to identify in how many patients the sonogram detected free fluid or a ren al parenchymal abnormality. Free fluid in the abdomen was identified in 19 of 32 patients (59%). However, 12 of these 19 patients had concomitant inju ry, such as splenic rupture requiring splenectomy, severe liver lacerations , or bowel lacerations requiring repair, that were possible causes of the f ree fluid. Eliminating these patients, only seven of 20 patients with isola ted renal injuries had free fluid in the abdomen (35%), whereas 13 of 20 pa tients (65%) had no evidence of free fluid. All seven patients with free fl uid had moderate or severe renal injuries. Renal parenchymal abnormalities were identified on ultrasonograms in eight of 37 (22%) of injured kidneys. The abnormalities were detected more commonly in cases of severe injury (60 %). In conclusion, acute injuries of the kidney from blunt abdominal trauma often are associated with significant splenic, hepatic, or bowel trauma. i solated renal injuries frequently occur without the presence of free fluid in the abdomen. Furthermore, the ultrasonogram of the kidney often is norma l with acute renal injuries, but it is more likely to be abnormal with seve re (grade II or greater) renal injuries. Sonography may be used in the tria ge of patients with blunt abdominal trauma and possible renal injury Howeve r, a negative ultrasonogram does not exclude renal injury, and, depending o n clinical and laboratory findings, other imaging procedures such as comput ed tomography should be performed.