- Email: [email protected]
Case profile: Traumatic fracture of pelvic kidney
URORADIOLOGY
I. \:,k, ~‘K~JFILE: TR4UMATIC
FRACTURE
\ fi\ ~a-!c’;LI.-old girl fell off‘ her l)icycle landing ;ind coinplained of increased pain ovel tllcl tlrlxt fi\.c> hours. On admissiorl to the hospital shca pssd grossly bloody Imine. She had lo\\er ;~Moinini~l tenderness bit no in;lss was p;11p”1’1e. An eycretor!. urogram revealed a nialrotated right kidney and a left pelvic kidney with incomplete visualization (Fig. l&A). There was no estravusation of contrast medium seen. li cystogram showed an intact bladder. The patient’s hematocrit was 27, and after transfusion of’ 500 ml. of blood, it remained onl>, 28. i\ tender lower al~doiiiinal mass also cle~~eloped. An arteriograin showed fracturt> of the pelvic kidnq, with partial a&ion of‘ thta lIpper pole. A short main renal artery was seen to arise from the internal iliac artery (Fig. IB, Ci. At surgical exploration, after control of the renal pedicle, a large retroperitoneal hernatoina was evacuated and the partiall!. avulsed left proll"
OF PELVIC
KIDNEY
upper pole of’ the kidney WAS relno\~ed. The patient had an uneven&l postoperative course. Excretory rmyqaphv three months postoperatively showed good &nction bilaterally. Although the excretory urogranr defined the presence of a pelvic kidney, the arteriogrmn was necessar!. to define the extent of the injiir);. Arteriograph~ should 1~ llndertaken early in patients with renal trauina who continile to show evidence of bleeding with conservative inanagenient. ‘j’ Exploration was performed earl) in this patient since there was evidence of’ persistent bleeding, and it was felt that effective tamponade of the kidney was less likely hecause of’ its al~nornial anatomic position. Ae~pelvic kidney is probably more vulnerable to blunt trauma, and its presence should 1~ considered particularly in patients with anteriol al)dominal trauma and hematuria. Demetrius
II. Bagley, M. D.
Osher Pais, M.D. Rernard Lytton. Xl. D. (Reprints) University of Chicago Chicago, Illinois 60637
I. \:,k, ~‘K~JFILE: TR4UMATIC
FRACTURE
\ fi\ ~a-!c’;LI.-old girl fell off‘ her l)icycle landing ;ind coinplained of increased pain ovel tllcl tlrlxt fi\.c> hours. On admissiorl to the hospital shca pssd grossly bloody Imine. She had lo\\er ;~Moinini~l tenderness bit no in;lss was p;11p”1’1e. An eycretor!. urogram revealed a nialrotated right kidney and a left pelvic kidney with incomplete visualization (Fig. l&A). There was no estravusation of contrast medium seen. li cystogram showed an intact bladder. The patient’s hematocrit was 27, and after transfusion of’ 500 ml. of blood, it remained onl>, 28. i\ tender lower al~doiiiinal mass also cle~~eloped. An arteriograin showed fracturt> of the pelvic kidnq, with partial a&ion of‘ thta lIpper pole. A short main renal artery was seen to arise from the internal iliac artery (Fig. IB, Ci. At surgical exploration, after control of the renal pedicle, a large retroperitoneal hernatoina was evacuated and the partiall!. avulsed left proll"
OF PELVIC
KIDNEY
upper pole of’ the kidney WAS relno\~ed. The patient had an uneven&l postoperative course. Excretory rmyqaphv three months postoperatively showed good &nction bilaterally. Although the excretory urogranr defined the presence of a pelvic kidney, the arteriogrmn was necessar!. to define the extent of the injiir);. Arteriograph~ should 1~ llndertaken early in patients with renal trauina who continile to show evidence of bleeding with conservative inanagenient. ‘j’ Exploration was performed earl) in this patient since there was evidence of’ persistent bleeding, and it was felt that effective tamponade of the kidney was less likely hecause of’ its al~nornial anatomic position. Ae~pelvic kidney is probably more vulnerable to blunt trauma, and its presence should 1~ considered particularly in patients with anteriol al)dominal trauma and hematuria. Demetrius
II. Bagley, M. D.
Osher Pais, M.D. Rernard Lytton. Xl. D. (Reprints) University of Chicago Chicago, Illinois 60637