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A broken kidney

BMJ 2005; 331 doi: (Published 01 October 2005) Cite this as: BMJ 2005;331:0510370
  1. Steven Kennish, senior house officer in urology1,
  2. M Murphy, consultant urologist1
  1. 1Pinderfields General Hospital

A 17 year old man was brought in to the accident and emergency department in the early hours of the morning having sustained an obvious head injury. He had been found wanW, dering by the roadside, smelled of alcohol, was agitated, and could not remember what had happened. On examination, doctors found a small scalp laceration and right flank bruising. No focal neurological signs could be elicited and no major musculoskeletal injuries were detected on examination. However, a urine specimen showed the patient had frank haematuria (blood in the urine altering its colour to the naked eye).

The consultant radiologist arranged urgent contrast enhanced computed tomography of the abdomen.


  1. What abnormality does the figure show?

  2. What other radiological test(s) could be useful to assess renal injury?

  3. What are the indications for further intervention?

  4. Apart from the loin injury, what else concerns you about the history and examination findings


  1. Fractured right kidney with associated haematoma.

  2. Intravenous urogram (IVU) gives information on whether the urine collecting system is intact, and renal angiography shows whether the blood supply to the kidneys is intact. CT, however, also provides accurate information on these and provides better definition than ultrasound examination.

  3. Haemodynamic instability indicating continued haemorrhage.

  4. The head injury combined with apparent retrograde amnesia may warrant CT of the head to assess for intracranial haemorrhage.

Organ injury scaling: kidney


  • 1. Contusion: microscopic/frank haematuria, urological studies normal Haematoma: subcapsular non-expanding without parenchymal laceration

  • 2. Haematoma: non-expanding perirenal confined to retroperitoneum Laceration: …

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