Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2010; 77(2):140-142 | DOI: 10.55095/achot2010/026

Poranění ledvin nižších stupňů (2. část): Validita ultrasonografie v diagnosticePůvodní práce

R. GRILL^1,*, V. BÁČA^2,3, M. OTČENÁŠEK⁴, F. ZÁŤURA⁵

¹ Urologická klinika 3. LF UK a FNKV, Praha

² Ústav anatomie 3. LF UK, Praha

³ Katedra lékařských a humanitních oborů Fakulty biomedicínského inženýrství ČVUT, Kladno

⁴ Ústav pro péči o matku a dítě, Praha-Podolí

⁵ Urologická klinika LF UP a FN, Olomouc

PURPOSE OF THE STUDY:
The aim of the study was to verify whether ultrasonography can be considered a reliable method for the diagnosis of low-grade renal trauma.

MATERIAL AND METHODS:
The group investigated included patients with grade I or grade II blunt renal trauma, as classified by the AAST grading system, in whom ultrasonography alone or in conjunction with computed tomography was used as a primary diagnostic method.
B-mode ultrasound with a transabdominal probe working at frequencies of 2.5 to 5.0 MHz was used. Every finding of post-traumatic changes in the renal tissues, i.e., post-contusion hypotonic infiltration of the renal parenchyma or subcapsular haematoma, was included. The results were statistically evaluated by the Chi-square test with the level of significance set at 5 %, using Epi Info Version 6 CZ software.

RESULTS:
The group comprised 112 patients (43 women, 69 men) aged between 17 and 82 years (average, 38 years). It was possible to diagnose grade I or grade II renal injury by ultrasonography in only 60 (54 %) of them. The statistical significance of ultrasonography as the only imaging method for the diagnosis of low-grade renal injury was not confirmed (p = 0.543).

DISCUSSION:
Low-grade renal trauma is a problem from the diagnostic point of view. It usually does not require revision surgery and, if found during repeat surgery for more serious injury of another organ, it usually does not receive attention. Therefore, the macroscopic presentation of grade I and grade II renal injury is poorly understood, nor are their microscopic findings known, because during revision surgery these the traumatised kidneys are not usually removed and their injuries at autopsy on the patients who died of multiple trauma are not recorded either.

CONCLUSIONS:
The results of this study demonstrated that the validity of ultrasonography for the diagnosis of low-grade renal injury is not significant, because this examination can reveal only some of the renal injuries such as perirenal haematoma. An injury to the renal parenchyma is also indicated by hypoechogenic areas of varying sizes in the renal cortex. A negative ultrasonographic finding is no proof of the absence of renal trauma. As low-grade renal injury is difficult to detect by mere clinical examination or by a single imaging method, the authors regard as necessary to actively look for them, taking into consideration the mechanism of injury, haematuria findings and evaluation of ultrasonographic and CT scans.

Klíčová slova: kidney injury, haematuria, sonography, computed tomography

Zveřejněno: 1. duben 2010  Zobrazit citaci