Waleed Eassa, M. Abo El-Ghar, Roman Jednak, Mohamed El-Sherbiny

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Nonoperative Management of Grade 5 Renal Injury in Children: Does It Have a Place? Waleed Eassa, M. Abo El-Ghar, Roman Jednak, Mohamed El-Sherbiny European Urology Volume 57, Issue 1, Pages 154-163 (January 2010) DOI: 10.1016/j.eururo.2009.02.001 Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 1 A contrast-enhanced arterial phase computed tomography (CT) image posttrauma showing active extravasation into the hematoma, indicating vigorous bleeding from the right kidney. European Urology 2010 57, 154-163DOI: (10.1016/j.eururo.2009.02.001) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 2 (a) Computed tomography (CT) scan showing a grade 5 traumatic injury of the left kidney; (b) a coronal reformatted image showing the shattered renal parenchyma and a lower-pole pseudoaneurysm; (c) selective angiography of the kidney prior to embolization identifies a pseudoaneurysm; (d) superselective angiography shows the pseudoaneurysm prior to embolization; (e) following embolization, the occluding microcoils can be seen, and there is nonfilling of the pseudoaneurysm. European Urology 2010 57, 154-163DOI: (10.1016/j.eururo.2009.02.001) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 3 (a) A contrast-enhanced arterial phase computed tomography (CT) image showing an intact arterial supply with multiple deep parenchymal lacerations in the right kidney; (b) a follow-up image showing preserved perfusion of the kidney, contrast excretion, and approximation of the shattered parenchymal fragments; (c) dimercaptosuccinic acid (DMSA) scan of the same patient shows loss of perfusion of the ipsilateral upper pole with preserved function of the remaining part, with split function of 30%. European Urology 2010 57, 154-163DOI: (10.1016/j.eururo.2009.02.001) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 4 An algorithm for the management of a grade 5 renal injury. PCD=percutaneous drainage. European Urology 2010 57, 154-163DOI: (10.1016/j.eururo.2009.02.001) Copyright © 2009 European Association of Urology Terms and Conditions