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JAMA Surgery Clinical Challenge
August 2018

Computed Tomography in a Patient With Blunt Trauma

Author Affiliations
  • 1Department of Surgery, University of Colorado School of Medicine, Aurora
  • 2Department of Surgery, Denver Health Medical Center, Denver, Colorado
JAMA Surg. 2018;153(8):772-773. doi:10.1001/jamasurg.2018.0307

A man in his 60s with a known history of a large cyst on the right kidney sustained blunt trauma in a skiing crash. Computed tomography (CT) showed a right-sided grade IV renal injury involving his known renal cyst with active arterial extravasation (Figure, A). The patient underwent selective angioembolization of the renal laceration.

In the 24 hours after embolization, the patient required 2 U of red blood cells via transfusion for anemia. On examination, the patient reported moderate pain in the abdomen and right side and demonstrated a distended abdomen in the absence of any peritoneal signs. Contrast-enhanced CT of the abdomen and pelvis was performed to assess for a source of continued bleeding (Figure, B).

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