Brown S L, Hoffman D M, Spirnak J P
Department of Urology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
J Urol. 1998 Dec;160(6 Pt 1):1979-81. doi: 10.1097/00005392-199812010-00008.
We have observed that injury to the renal collecting system may be missed during routine abdominal spiral computerized tomography (CT) for trauma. A definitive protocol for spiral CT has been established to identify all cases of renal collecting system injury.
A retrospective review of 35 consecutive cases of blunt renal trauma evaluated with spiral CT between 1994 and 1997 at our Level I trauma center was performed. Each patient received 100 cc intravenous contrast at 2 cc per second. There was a 60-second delay after the start of contrast infusion before scanning was initiated.
Of the 35 cases 3 (8.6%) injuries to the renal collecting system were detected on delayed scans obtained after the initial CT failed to demonstrate contrast extravasation. Therefore, at our institution we have modified the protocol for spiral CT for abdominal trauma by repeating scans of the kidneys after the initial scans are completed.
Injury to the renal collecting system may be missed during routine spiral CT, thereby incorrectly under staging renal trauma. In all cases of suspected blunt renal trauma evaluated with spiral CT repeat scans of the kidneys should be performed.
我们观察到，在常规腹部螺旋计算机断层扫描（CT）检查创伤时，可能会漏诊肾集合系统损伤。已制定了螺旋CT的明确方案，以识别所有肾集合系统损伤病例。
对1994年至1997年期间在我们的一级创伤中心接受螺旋CT评估的35例连续性钝性肾外伤病例进行回顾性研究。每位患者以每秒2毫升的速度静脉注射100毫升造影剂。在开始注射造影剂后60秒延迟，然后开始扫描。
在35例病例中，3例（8.6%）肾集合系统损伤在初始CT未能显示造影剂外渗后获得的延迟扫描中被检测到。因此，在我们机构，我们修改了腹部创伤螺旋CT方案，在初始扫描完成后重复扫描肾脏。
在常规螺旋CT检查期间，可能会漏诊肾集合系统损伤，从而错误地低估肾外伤的分期。在所有怀疑钝性肾外伤并接受螺旋CT评估的病例中，均应进行肾脏重复扫描。
