The patient has an injury to the right kidney. CT scan is the investigation of choice for haematuria in the haemodynamically stable patient. It allows assessment of the grade of renal injury and identifies areas of renal infarction. The whole abdomen and retroperitoneum is imaged for concurrent injury.

A FAST (Focused Abdominal Sonography for Trauma) is of value in the haemodynamically unstable patient. However the FAST scan looks only for intraperitoneal (and intrapericardial) blood and does not adequately image the retroperitoneum. Similarly a diagnostic peritoneal lavage will miss this injury.

Intravenous urography is only 90% sensitive even under ideal conditions. It is of no value in hypertensive patients where renal perfusion is inadequate. It does not image the retroperitoneum and does not grade renal injuries. Its utility in trauma patients is extremely limited and it should probably be abandoned.

See: Renal Trauma