Unilateral nonvisualization on excretory urography after external trauma.

Unilateral nonvisualization on excretory urography after external trauma indicates serious consequences for the kidney, since traumatic main renal artery occlusion has been the most common cause of this finding. We evaluated 53 patients with unilateral nonvisualization on excretory urography following blunt (47) and penetrating (6) trauma. All but 1 patient had multiple injuries from severe external trauma. The renal injury causing the nonvisualization was contusion in 8 patients, laceration in 12, rupture in 12 and renal pedicle in 21. Further investigations required to diagnose the type of renal injury consisted of repeat excretory urography in 2 patients, renal arteriography in 14, renal exploration in 36 and autopsy in 1. Early diagnosis was mandatory if the kidney was to be salvaged by surgical repair of the main artery occlusion or if the appropriate management was to be used for the lesser degrees of renal injury, such as rupture, laceration and contusion.