Grade I: Minor contusion or non-expanding subcapsular hematoma without parenchymal laceration.
Axial CT scan through the upper abdomen in a patient who presented with hematuria following blunt trauma to the right kidney shows a high-density perinephric hematoma with induration in the perirenal fat but no hematoma in the region. The right kidney is atrophied.
Ashley Davidoff MD TheCommonVein.net 29619
Grade II: Non-expanding perirenal hematoma confined to the retroperitoneum without parenchymal laceration.
Ashley Davidoff MD TheCommonVein.net
Grade II Parenchymal laceration less than 1 cm deep without urinary extravasation.
Axial CT scan in the nephrographic phase through the upper abdomen in a patient who presented with hematuria following blunt trauma to the right kidney. A less than 1cms laceration in the medial aspect of the kidney is noted with a perinephric hematoma and a small amount of fluid in Morrison’s pouch. No injury to the collecting system was noted on the excretory phase
Ashley Davidoff MD TheCommonVein.net 135631
Grade III >1cms Laceration Intact Collecting System
Axial CT through the middle of the kidneys showing a deep, greater than 1cms, laceration in the right kidney with a perinephric hematoma and with intact collecting system
Ashley Davidoff MD TheCommonVein.net 135620
Grade IV Vascular Injury or Active Bleeding confined within the Perirenal Fascia
Axial CT scan in the pyelographic phase through the upper abdomen in a patient who presented with blunt trauma to the right kidney. There is a perfusion defect in the anterior aspect of the right kidney that involves both the cortex and medulla and extends to the capsular surface with evidence of thin rim of cortical enhancement, due to capsular perfusion. (“cortical rim sign”) and suggesting segmental arterial compromise.
Ashley Davidoff MD TheCommonVein.net 20267
Grade IV Complete Ureteropelvic Disruption
Ashley Davidoff MD TheCommonVein.net
Grade V De-vascularized Kidney
Abdominal aortography shows a complete occlusion of the right renal artery as a result of blunt trauma.
Ashley Davidoff MD TheCommonVein.net 00086c
Grade V UPJ Avulsion
Axial CT scan in the nephrographic phase through the upper abdomen in a patient who presented with severe blunt trauma to the left kidney. A faceless left kidney results from a shattered kidney as well as vascular compromise. Most of the kidney is non-functioning except for small remnants of perfusing renal parenchyma. The vein and artery are irregular and small suggesting associated injury. Perinephric hematoma is also present.
Ashley Davidoff MD TheCommonVein.net 135635