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Significance of hematoma size for evaluating the grade of blunt renal trauma
Y Ichigi1, N Takaki, K Nakamura
1Department of Surgery, Saga Medical School, Japan. ichigi-y@ann-hi-ho.ne.jp
Insights
The ratio of hematoma area to body area on CT scans is a valuable tool for assessing blunt renal trauma severity. Monitoring hematoma size changes aids in guiding conservative management strategies for these injuries.
Area of Science:
- Radiology
- Trauma Surgery
- Urology
Background:
- Blunt renal trauma management decisions require objective parameters.
- Hematoma size relative to body size is a potential metric for evaluation.
Purpose of the Study:
- To determine the utility of hematoma size relative to body size in managing blunt renal trauma.
- To assess the effectiveness of computed tomography (CT) measurements in grading renal trauma.
Main Methods:
- Retrospective analysis of 33 patients with intermediate to severe blunt renal trauma (1982-1997).
- Patients categorized into conservative management, embolization with bedrest, and operative groups.
- Measurement of hematoma area (H) and hematoma area to body area ratio (H/B) on CT scans.
Main Results:
- Significantly larger H and H/B in the operative group compared to the conservative group.
- H/B ratio provided clearer group differentiation than H alone.
- Conservative management with embolization allowed for kidney preservation despite large hematomas.
- H/B ratio in the conservative group decreased over time, normalizing by 40-50 days post-injury.
Conclusions:
- The hematoma area to body area ratio on CT is highly effective for grading blunt renal trauma.
- Changes in hematoma size are crucial indicators for guiding conservative treatment in blunt renal trauma.
Background:
The hematoma size relative to the body size was measured on computed tomography films using a personal computer system in order to define whether that parameter is useful for decision-making in the management of blunt renal trauma.
Methods:
From 1982 to 1997, 33 patients with intermediate or severe grade blunt renal trauma were retrospectively divided into three groups: group 1, managed conservatively without transcatheter embolization; group 2, managed by bedrest after selective transcatheter embolization; and group 3, managed operatively. In these three groups, the hematoma area (H) and the ratio of hematoma area to body area on CT (H/B) were measured and the chronological changes of the H/B in groups 1 and 2 were studied.
Results:
The H and H/B of group 3 were significantly larger than those of group 1. The H/B was more clearly distinguished for each group compared with the H alone. Well-preserved kidney integrity, despite the presence of a large hematoma in group 2, allowed the conservative treatment following transcatheter embolization of the bleeding site. The H/B of all group 1 patients gradually decreased and on the 40th or 50th day after injury they reached a level equivalent to the ratio of contra-lateral normal kidney area to body area.
Conclusion:
The ratio of hematoma area to body area on CT was very useful in evaluating the grade of blunt renal trauma. In conservative treatment for blunt renal trauma changes of the hematoma size is a useful indicator for management.