Imaging findings of high-grade penetrating renal trauma in a pediatric patient

Abstract

Renal trauma is a significant cause of morbidity in pediatric patients, with penetrating injuries representing a smaller but severe subset. We present the case of an 11-year-old boy with a penetrating stab wound to the left flank causing hemodynamic instability. Initial ultrasound revealed free fluid in the perirenal space, prompting a contrast-enhanced thoracoabdominal-pelvic CT scan, which demonstrated a grade V left mid-renal laceration extending to the hilum with devascularization of the medial renal parenchyma and active arterial contrast extravasation near the renal pedicle. A large perirenal and pararenal hematoma extended into the intraperitoneal space, confirming ongoing hemorrhage. Imaging findings guided a multidisciplinary decision for conservative management under intensive monitoring. This case underscores the critical role of multiphase CT imaging in accurately grading pediatric penetrating renal trauma, identifying vascular injury and hemorrhage, and guiding appropriate management decisions.