Case profile of the month

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FIGURE 3. Nephrogram phase of arteriogram demonstrating left pelvic kidney; no disruption or ertravasa tion seen.

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PROFILE

A sixteen-year-old girl sustained multiple pelvic fractures following an automobile accident (Fig. 1). Gross hematuria with clots and hypotension ensued. Her blood pressure stabilized after she received 4 units of whole blood, but hematuria continued. An intravenous pyelogram showed prompt function on the right with no extravasation. The left kidney did not visualize. It should be noted that the radiologist outlined the borders of the left nonvisualizing kidney (Fig. 2). A renal pedicle and arteriography was injury was suspected, performed. The arteriogram showed the left kidney to be situated in the pelvis and to be grossly intact with no evidence of fracture or urinary extravasation (Fig. 3). The celiac axis films failed to show any other associated intra-abdominal conditions. Urologic consultation was obtained after the arteriogram was performed. Her condition stabilized, and operative intervention was unnecessary.

UROLOGY

/ JANUARY 1975

/ VOLUME V, NUMBER

1

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This case demonstrates several important points: (1) Expert arteriography rather than retrograde pyelography provides more meaningful information in most instances of trauma. (2) A simultaneous assessment of associated intraabdominal conditions can be made. (3) The time and effort to organize and perform retrograde studies can better be utilized for arteriography. In this case the pelvic fractures would have obviated retrograde films. (4) It is always important to look for a pelvic kidney when dealing with supposed nonvisualization on one side. (5) Do not permit our radiologic colleagues to usurp the continued necessity for viewing and interpreting x-ray films ourselves. The pelvic kidney can readily be seen in retrospect on the four-minute film.

Richard M. Ehrlich, M.D. University of California, Los Angeles The Center for Health Sciences Los Angeles, California 90024

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