Computerized tomographic staging of renal trauma: 85 consecutive cases.

In 85 patients with renal trauma we compared the findings on computerized tomography with those of excretory urography, renal surgery, intra-abdominal surgery and angiography. Patients underwent computerized tomography because of a suspected associated thoracic or abdominal injury, or indeterminate findings on excretory urography, nephrotomography or angiography. Blunt trauma accounted for 87.1 per cent of the renal injuries and penetrating trauma for 12.9 per cent. The most common findings on computerized tomography were perirenal hematoma in 29.4 per cent, intrarenal hematoma in 24.7 per cent and parenchymal disruption in 17.6 per cent. In 33 patients who underwent laparotomy computerized tomographic staging was confirmed. In contrast, the most common finding on excretory urography, diminished opacification (17 of 53 patients), was found to have no correlation with the severity of renal injury as assessed by computerized tomography or laparotomy. Angiography appreciably understaged 1 of 5 cases by failing to show extracapsular extravasation with parenchymal disruption. All findings on angiography were depicted by computerized tomography. We conclude that computerized tomographic staging for renal trauma is more sensitive and specific than excretory urography, nephrotomography and angiography, and that it should be used primarily when multiple traumatic injuries are suspected, when excretory urography suggests major trauma or is nonspecific and when clinical evidence of major trauma exists, regardless of what excretory urography shows.