Question

There was patient of Kidney trauma with hematuria. Which of the following investigation is advised to localised the site of hematuria

• A. CT
• B. X-ray
• C. MRI
• D. USG

Hint:

In trauma with haematuria, think of which modality can simultaneously image the parenchyma, collecting system, and active bleeding in one scan.

Answer 1

The Correct Option is A

Step 1: Understand the clinical question. A patient with kidney trauma presenting with hematuria needs an investigation to localise the site of bleeding. This requires an imaging modality that can assess the entire urinary tract with high resolution and detect active extravasation of blood.

Step 2: Evaluate each option.

• CT (CT IVP / CT urogram): Gold standard investigation for haematuria in the setting of renal trauma. CT intravenous pyelogram (IVP) with contrast phases (arterial, venous, and delayed/excretory) can identify: renal lacerations, cortical tears, collecting system injuries, ureteric injuries, and active contrast extravasation indicating active haemorrhage. The AAST (American Association for the Surgery of Trauma) grading of renal injury is based on CT findings.
• X-ray: Cannot visualise the renal parenchyma or collecting system adequately; only useful to detect bony injury or foreign bodies.
• MRI: Excellent soft tissue resolution but impractical in emergency/trauma settings; contraindicated if metallic foreign bodies are present.
• USG: Can detect free fluid (FAST) but cannot reliably grade renal injuries or detect collecting system disruption.

Step 3: Conclusion. CT is the recommended first-line investigation for renal trauma with haematuria to localise the injury site and grade the severity.