Case 28: Trauma and Haematuria
Monday, September 19th, 2011Author: Dr Ian Stell
A 20 year old male presented soon after he began passing heavily blood-stained urine (shown). Two days previously he had fallen from a wall. He had been drinking, and fell awkwardly; his foot was caught in a metal fitting holding his foot against the wall so that he fell on his chest and face. He felt that he was okay at the time and went home.
The following evening he realised how sore his jaw was and presented to A&E, when no fracture was found.
A day later he developed the gross haematuria suddenly. He also reported a vague upper abdominal pain. BP was 136/80, Pulse 66/min, on abdominal examination there was a mild discomfort in the right loin.
1. What imaging would you order – ultrasound, IVU or CT?
Click to see the answerCT scanning with intravenous contrast is the best option, and has superseded IVU and ultrasound. The main advantages are around: broad assessment of abdominal structures, the contrast gives an indication of kidney function, and the quality of detail of the parenchyma seen on CT.
This is the coronal CT, showing a haematoma of the inferior pole of the right kidney, and a small tear in the parenchyma.
2. If haematuria was microscopic (on dipstick) rather than gross, would this change your decision regarding the need for imaging?
Click to see the answerIt has been well established that in the absence of: gross haematuria, shock or other major injury, imaging is not required. Many patients with trauma to the renal areas have microscopic haematuria – but this is a benign finding.