Imaging characteristics associated with failure of nonoperative management in high-grade pediatric blunt renal trauma

Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM (P=0.01). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) (P=0.01). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management.

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Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review

European Urology Supplements ◽

10.1016/s1569-9056(18)32053-0 ◽

2018 ◽

Vol 17 (2) ◽

pp. e1737 ◽

Cited By ~ 2

Author(s):

A. Sujenthiran ◽

P.J. Elshout ◽

E. Veskimae ◽

Y. Abu-Ghanem ◽

S. MacLennan ◽

...

Keyword(s):

Systematic Review ◽

Nonoperative Management ◽

Renal Trauma ◽

High Grade ◽

First Line

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170: Nonoperative Management of Blunt Renal Trauma: Is Routine Follow-Up Imaging Necessary?

The Journal of Urology ◽

10.1016/s0022-5347(18)30435-x ◽

2007 ◽

Vol 177 (4S) ◽

pp. 57-58

Author(s):

John B. Malcolm ◽

Reza Mehrazin ◽

Christopher J. DiBlasio ◽

David D. Vance ◽

Robert W. Wake ◽

...

Keyword(s):

Nonoperative Management ◽

Renal Trauma

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MSCT IN NON-OPERATIVE MANAGEMENT OF HIGH GRADE BLUNT RENAL TRAUMA, A PROSPECTIVE STUDY

Zagazig University Medical Journal ◽

10.21608/zumj.2018.18295 ◽

2018 ◽

Vol 24 (6) ◽

pp. 526-543

Author(s):

Rania Almolla ◽

Hanan Hassan ◽

Amr Fawzi

Keyword(s):

Prospective Study ◽

Operative Management ◽

Renal Trauma ◽

High Grade ◽

A Prospective Study ◽

Non Operative Management

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Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma

Cancers ◽

10.3390/cancers13050945 ◽

2021 ◽

Vol 13 (5) ◽

pp. 945

Author(s):

Ryota Sagami ◽

Kentaro Yamao ◽

Jun Nakahodo ◽

Ryuki Minami ◽

Masakatsu Tsurusaki ◽

...

Keyword(s):

Pancreatic Duct ◽

Invasive Carcinoma ◽

Current Knowledge ◽

Precancerous Lesions ◽

Ductal Adenocarcinoma ◽

Pancreatic Ducts ◽

High Grade ◽

Cytologic Examination ◽

Imaging Characteristics ◽

Retention Cysts

Pancreatic ductal adenocarcinoma (PDAC) arises from precursor lesions, such as pancreatic intra-epithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). The prognosis of high-grade precancerous lesions, including high-grade PanIN and high-grade IPMN, without invasive carcinoma is good, despite the overall poor prognosis of PDAC. High-grade PanIN, as a lesion preceding invasive PDAC, is therefore a primary target for intervention. However, detection of localized high-grade PanIN is difficult when using standard radiological approaches. Therefore, most studies of high-grade PanIN have been conducted using specimens that harbor invasive PDAC. Recently, imaging characteristics of high-grade PanIN have been revealed. Obstruction of the pancreatic duct due to high-grade PanIN may induce a loss of acinar cells replaced by fibrosis and lobular parenchymal atrophy. These changes and additional inflammation around the branch pancreatic ducts (BPDs) result in main pancreatic duct (MPD) stenosis, dilation, retention cysts (BPD dilation), focal pancreatic parenchymal atrophy, and/or hypoechoic changes around the MPD. These indirect imaging findings have become important clues for localized, high-grade PanIN detection. To obtain pre-operative histopathological confirmation of suspected cases, serial pancreatic-juice aspiration cytologic examination is effective. In this review, we outline current knowledge on imaging characteristics of high-grade PanIN.

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Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes

Seminars in Interventional Radiology ◽

10.1055/s-0041-1724010 ◽

2021 ◽

Vol 38 (01) ◽

pp. 105-112

Author(s):

Majd Habash ◽

Darrel Ceballos ◽

Andrew J. Gunn

Keyword(s):

Clinical Outcomes ◽

Splenic Artery ◽

Splenic Injury ◽

Nonoperative Management ◽

Operative Management ◽

Splenic Trauma ◽

Trauma Patients ◽

High Grade ◽

Artery Embolization ◽

Splenic Artery Embolization

AbstractThe spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.

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