Imaging assessment of renal injuries in children and adolescents: CT or ultrasound?

BackgroundSince the introduction of the ALARA (“as low as reasonably achievable”) concept, ultrasound (US) has been progressively advocated for paediatric diagnostic imaging. This study aimed to analyse the role and accuracy of US in paediatric renal trauma.MethodsFrom 1999 to 2009, the tertiary-care-hospital database was retrospectively evaluated for renal trauma with regards to aetiology, type of injury, diagnostics, management and outcome.ResultsForty-seven patients (29 males, 18 females; median age = 14 years, range 1–17 years) were identified. US was initially applied in 45 patients with correct results in 86.6%. Computed tomography (CT) was performed in 16 patients in the acute trauma setting — complementary to US in 14 cases, with a diagnostic accuracy of 93%. Most renal injuries were grade I° (n = 30), followed by grade III° (n = 8), IV° (n = 5), and II°/V° (n = 2 each). All patients were initially managed conservatively and followed by US. Clinical deterioration necessitated surgery in four patients (2 nephrectomies, 1 partial nephrectomy, 1 urinoma drainage). The outcome was generally favourable with a renal preservation rate of 95%.ConclusionWith respect to the ALARA principle, US can be safely and reliably applied as the first-line diagnostic imaging technique and for follow-up for suspected traumatic paediatric renal injuries.