In the setting of hemodynamic instability and renal or pelvic artery extravasation detected by CT, arteriography may be used to guide endovascular embolization. Arteriography may also be used to guide the treatment of CT-detected post- traumatic pseudoaneurysms and arteriovenous fistulas [91,92]. MRI MRI is not appropriate in the initial evaluation of traumatic macroscopic hematuria. CT (including CT cystography) Unlike in adults, no firm consensus has been reached on the best guidelines for imaging in pediatric blunt abdominopelvic trauma and microscopic hematuria [71,79]. For adult patients with isolated microscopic hematuria without coexistent injury, there is evidence that renal imaging with CT is unlikely to disclose clinically significant findings [67,70-72]. However, the evidence for that in children is limited. A study by Nguyen and Das [71] found that 12 of 32 (37.5%) with grades 2 to 5 renal injuries did not have macroscopic hematuria; 8 had microscopic hematuria, and 4 had normal urinalyses. Thus, the authors concluded that significant renal injuries can be encountered in the setting of microscopic hematuria, and the decision to perform CT should be based on history and mechanism of injury and not urinalysis alone. Children with congenital renal abnormalities (eg, UPJ obstruction), multiorgan injury, history of deceleration injury, localized flank pain, and ecchymosis should undergo CT imaging to evaluate for renal injury, even when gross hematuria is not present. Renal injury without macroscopic hematuria can also be found in a child with falling hemoglobin or a hemodynamic instability [70,72]. Microscopic hematuria has also been combined with other clinical variables to create prediction rules for identifying children with intra-abdominal injuries following blunt abdominal trauma [95]. Patients with hematuria, even microscopic, in the setting of pelvic fractures are at risk for bladder injury. Dedicated CT cystography is an accurate method of evaluation of bladder injury [81-83].
Hematuria Child. In the setting of hemodynamic instability and renal or pelvic artery extravasation detected by CT, arteriography may be used to guide endovascular embolization. Arteriography may also be used to guide the treatment of CT-detected post- traumatic pseudoaneurysms and arteriovenous fistulas [91,92]. MRI MRI is not appropriate in the initial evaluation of traumatic macroscopic hematuria. CT (including CT cystography) Unlike in adults, no firm consensus has been reached on the best guidelines for imaging in pediatric blunt abdominopelvic trauma and microscopic hematuria [71,79]. For adult patients with isolated microscopic hematuria without coexistent injury, there is evidence that renal imaging with CT is unlikely to disclose clinically significant findings [67,70-72]. However, the evidence for that in children is limited. A study by Nguyen and Das [71] found that 12 of 32 (37.5%) with grades 2 to 5 renal injuries did not have macroscopic hematuria; 8 had microscopic hematuria, and 4 had normal urinalyses. Thus, the authors concluded that significant renal injuries can be encountered in the setting of microscopic hematuria, and the decision to perform CT should be based on history and mechanism of injury and not urinalysis alone. Children with congenital renal abnormalities (eg, UPJ obstruction), multiorgan injury, history of deceleration injury, localized flank pain, and ecchymosis should undergo CT imaging to evaluate for renal injury, even when gross hematuria is not present. Renal injury without macroscopic hematuria can also be found in a child with falling hemoglobin or a hemodynamic instability [70,72]. Microscopic hematuria has also been combined with other clinical variables to create prediction rules for identifying children with intra-abdominal injuries following blunt abdominal trauma [95]. Patients with hematuria, even microscopic, in the setting of pelvic fractures are at risk for bladder injury. Dedicated CT cystography is an accurate method of evaluation of bladder injury [81-83].