A 24-year-old man involved in a road traffic accident arrives haemodynamically stable with left loin pain and microscopic hematuria. There are no other injuries. What is the next best investigation?

• A IVU with tomograms
• B Ultrasound KUB alone
• C Renal angiography
• D Contrast-enhanced CT scan of the abdomen with delayed excretory phase ✓

Explanation

Contrast-enhanced multiphasic CT with a delayed phase is the investigation of choice for suspected renal trauma in a stable patient. It grades the injury, identifies urinary extravasation on delayed films, detects devitalised fragments and shows associated intra-abdominal injuries. IVU is obsolete in acute trauma, ultrasound cannot grade parenchymal injury reliably or detect urinary leak, and angiography is reserved for therapeutic embolisation of active bleeding rather than first-line imaging. Stable patients with low-grade injuries are managed conservatively regardless.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.