When the Game Takes a Toll: Acute Flank Pain and Hematuria in a High School Athlete

GNYACSM Clinical Case Abstract When the Game Takes a Toll: Acute Flank Pain and Hematuria in a High School Athlete C. MILLER DO, A. CHAUDARY MD, K. LEONARD MD, & B. JONES M.ED., ATC Saratoga Hospital Family Medicine Residency, Saratoga Springs New York Category: Professional Advisor / Mentor: Back, Ephraim [email protected] ABSTRACT CASE HISTORY: A 16 year old male presented to the ER with left sided flank pain and hematuria. Three days prior he was tackled during a football game and immediately had pain on his side. Heating, stretching and taking Tylenol did not improve symptoms. He did not practice over the weekend due to pain. He noticed blood in his urine on the day of presentation but denied any frank blood or dysuria. PHYSICAL EXAM: Abdomen: mild left upper and lower quadrant tenderness, left CVA tenderness DIFFERENTIAL DIAGNOSES: Renal Laceration, Muscle injury, Rhabdomyolysis, Splenic Injury TESTS & RESULTS: Urinalysis: Nitrite, Leukocyte, Ketones: negative, Blood: Large, WBC: 11-25/hpf, RBC: >200/hpf; CBC: RBC 4.45, H/H 13.4/39.4 CK: 255 CT Abdomen Pelvis: Abnormal left kidney with parenchymal defect & perinephric edema consistent with intraparenchymal laceration 3cm high density focus adjacent to hilum, hematoma vs devascularized parenchyma. FINAL DIAGNOSIS: Grade III renal laceration DISCUSSION: Renal injuries represent the 3rd most common type of abdominal organ trauma. In athletic activities, these injuries typically result from blunt force trauma or excessive physical exertion. Blunt trauma may lead to renal contusions or lacerations, with pediatrics exhibiting greater susceptibility. When there are concerns of retroperitoneal injury this should be evaluated through CT scans, which can determine kidney trauma grading. Most renal lacerations are Grade I-III and are managed supportively. Grade V lacerations require renal exploration surgery. Patients who do not have indications for surgery can be managed with pain control, serial imaging and laboratory studies. The majority of nonoperative kidney lacerations heal in 6 weeks. OUTCOME OF THE CASE: His repeat hemoglobin and hematocrit were unchanged. Since he was hemodynamically stable with no evidence of acute bleeding, there was no indication for surgical intervention. He was discharged with close urology follow up outpatient. He was removed from all physical activity. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: He was removed from activity for 4 weeks. An ultrasound 4 weeks after showed a residual small left perinephric hematoma. He was transitioned to light activities for 3 months, then to full activities. A repeat ultrasound at 14 weeks showed no residual pathology.