· Large areas of laceration area noted involving mid and lower pole of right kidney with its complete non enhancement on contrast images. Part of upper and mid poles shows contrast enhancement through upper segmental branches. Large perinephric hyperdense fluid / hematoma measuring 8.7x7.1x10.6cm (APxMLxSI) is noted.
Right renal artery is well contrast opacified upto the renal hilum. Right renal vein also shows faint contrast opacification.
On delayed images, there is extravasation of contrast into the perinephric space is noted likely due to renal pelvic injury.
· Left kidney measures 9.8x 5cm in size and shows prompt nephrogram and good excretion of contrast. Left ureters appear normal in course and caliber.
· Liver is normal in size with no focal lesion and shows normal contrast enhancement.
· Gall bladder is distended with normal wall thickness.
· Pancreas appears normal and shows normal contrast enhancement. CBD appears normal.
· Spleen is normal in size. It shows normal contrast enhancement.
· Aorta, IVC, portal vein, SV, SMV and SMA appears normal.
· Both adrenals are normal.
· Urinary bladder appears partially distended, foleys bulb noted in situ.
· Prostate appears normal.
· Gross free fluid is noted in abdomen and pelvis with average CT value 30-35 HU likely hemoperitoneum.
· Mild right sided pleural effusion is noted.
· Visualised bowel loops appear normal. Ileoceacal junction appears normal.
· Hypodense area is noted in Left gluteus muscle measuring 2.2x1.7 cm ? Hematoma.
· Visualised lung parenchyma appears normal.
· Visualised bones appear normal. Spondylolysis is noted at L4-L5 vertebral level bilaterally.
Impression:
· Large areas of laceration area noted involving mid and lower pole of right kidney with its complete non enhancement on contrast images with extravasation of contrast on delayed images ( AAST Grade IV renal injury.)
· Gross hemoperitoneum and retroperitoneal hematoma on right side.