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

## TL;DR

A child with severe kidney injury from a stab wound was managed using detailed imaging to guide treatment decisions.

## Contribution

Demonstrates the use of multiphase CT imaging in grading pediatric penetrating renal trauma and guiding management.

## Key findings

- Contrast-enhanced CT identified a grade V renal laceration with devascularization and active bleeding.
- Imaging confirmed a large hematoma extending into the intraperitoneal space.
- Conservative management was guided by imaging findings to avoid unnecessary surgery.

## 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.