Endgames Picture Quiz

Flank pain and haematuria

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b5443 (Published 31 December 2009) Cite this as: BMJ 2009;339:b5443
  1. Euan Green, specialist trainee 3 in urology,
  2. Zubeir Ali, specialist trainee 3 in urology
  1. 1Royal Blackburn Hospital, Blackburn BB2 3HH
  1. Correspondence to: euan{at}doctors.org.uk

    A 25 year old man presented to the accident and emergency department after waking up with severe left sided abdominal pain and visible blood in his urine. He had no history of other urinary or gastrointestinal symptoms and felt well otherwise. Although he could not recall any traumatic injury, he had been drinking alcohol the night before and his memory of events was somewhat patchy. He was normally fit and well and had no medical history of note.

    On examination he was haemodynamically stable. We found no evidence of bruising or other injury to his abdomen or genitalia. His abdomen was soft and mildly tender to palpation on the left flank. His haemoglobin and renal function were normal. Although he had frank haematuria when he arrived at the hospital, this rapidly cleared. To investigate further, he underwent a contrast enhanced computed tomography scan of his abdomen (fig 1).

    Fig 1 Abdominal computed tomogram

    Questions

    • 1 What is the diagnosis?

    • 2 What signs are visible on the computed tomogram?

    • 3 How would you grade this injury?

    • 4 How should this patient be managed?

    Answers

    Short answers

    • 1 The patient has a left renal injury.

    • 2 He has a laceration through the left kidney posteriorly, with extravasation of contrast and a perinephric haematoma.

    • 3 This is a grade 4 renal injury.

    • 4 Renal …

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