[Ultrasound for initial evaluation of post-traumatic renal lesions in children].

PURPOSE: To describe the findings and limitations of color doppler ultrasound (CDUS) compared to enhanced CT in the evaluation of pediatric renal trauma and to determine the indications for first line imaging work up.

PATIENTS AND

METHODS

17 children (9 girls) aged 3 to 18 years were shown to have one or multiple post-traumatic renal lesions. All renal lesions were unilateral. All children presented with hematuria (microscopic (n=8), gross (n=7), not specified (n=2)). 16 had CDUS and enhanced CT (gold standard). A 13-year old girl had been imaged by both CDUS and IVU.

RESULTS

No correlation between the degree of hematuria and the severity of renal lesion could be found. Final diagnosis was: fracture with uro-hematoma (n=6), contusion (n=5), pedicular lesion (n=2), clotted ureter (n=1), intra cystic hemorrhage (n=1), subcapsular hematoma (n=1), urinoma with no evidence of fracture (n=1), extra-urinary lesion (n=7). In four cases, CDUS was abnormal but the diagnosis of fracture had not been made. In 3 cases, a uro-hematoma was present and CDUS misdiagnosed a pedicular lesion.

CONCLUSION

Imaging strategy should not rely on the type of hematuria. Presence of a urinoma alters the sensitivity of CDUS. When performed in ideal conditions, a comprehensive normal CDUS examination is probably sufficient to exclude a major renal injury.