March Case of the Month- courtesy of Dr. Lopez

A 22yo female was brought in by EMS after a syncopal episode while in the subway- at which time she fell onto the tracks.  Her primary survey was negative for any acute life threatening injuries.  She later developed flank and abdominal pain during her course in the ED and had an episode of hematuria.  Repeat bedside eFAST revealed the following:

The images reveal free fluid at the inferior renal pole as well as a renal hematoma.  A CT was obtained which revealed a right lower pole renal laceration with active extravasation consistent with a grade III injury.  She was taken to IR for angio-embolization, which she tolerated well.

Isolated renal injuries rarely present with free intraabdominal fluid, unless they are significant (Grade III), and usually traumatic renal injuries have associated concomitant splenic, diaphragmatic, bowel or hepatic trauma.  If you are able to visualize free fluid in association with a renal injury, additional imaging is recommended to evaluate for other associated trauma.