Percutaneous transcatheter super-selective embolization of a tributary of an accessory renal artery to control traumatic haematuria from a horseshoe kidney-a case report
Bibliographic record
Abstract
Objectives: The most experienced clinicians could easily miss serious renal injury at surgery. We report a case of a recently diagnosed bleeding from a lacerated horseshoe kidney with a review of the literature. Methods: The clinical and imaging records and laboratory results of a patient with blunt abdominal trauma were reviewed who initially underwent splenectomy for splenic injury, but a renal injury was missed at laparotomy. We also carried out a review of published reports of renal artery injuries. Results: A thirty-year-old man was admitted as an emergency to a hospital after he had sustained blunt abdominal trauma in a go-carting accident. He underwent splenectomy for splenic injury following which he was discharged. A few days later, he was seen in another hospital complaining of left loin pain where, a provisional diagnosis of urinary tract infection and possible haematoma around his splenic bed was made. He discharged himself against medical advice before further imaging could be undertaken. He presented to a third hospital with abdominal pain and then developed haematuria severe enough for him to be transfused. Ultra-sound scan and CT-scan of the abdomen and pelvis showed injury to a horseshoe kidney with haematoma which was initially drained percutaneously. Post contrast axial CT scans showing the transacted kidney and active renal bleeding are shown in Figures 1 & 2. A selective renal artery angiogram confirmed bleeding from a tributary of an accessory descending left renal artery that was successfully treated by super-selective embolization (Figures 3, 4, 5 and post embolization CT Figure 6). Conclusions: Ultrasonography and Computed Tomography are instrumental in the diagnosis of a horseshoe kidney. Both ultrasound and CT scans confirm a renal/peri-renal haematoma resulting from renal trauma. Selective renal artery angiography not only confirms the source of bleeding but also allows superselective arterial embolization as a definite or stopgap treatment.Super-selective embolization of renal haemorrhage is comparatively non-invasive and preferred to open surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".