The Luck of a Traumatic Accident
Author(s): Laserna del Gallego Cristina, Gutiérrez Velicia Soraya, Alberdi Iglesias Ana, Gómez Martín Blanca*, Manchón Leal M Judith and Rubio Babiano Ana Isabel
Abstract
Case Description
6-year-old, transferred for 112 due to trauma to the right side after nailing a 5-8cm rusty garden bar while pruning.
Case Description
6-year-old, transferred for 112 due to trauma to the right side after nailing a 5-8cm rusty garden bar while pruning.
Physical Exploration
Hemodynamically stable. Chest: normal PCA. Superficial 8th rib anterior thorax wound. Abdomen: circular puncture wound on the
lower right side, diameter <0.5cm, depth> 3cm.
Supplementary Tests
Abdominal CT: Right lateral abdominal wall wound with
intramuscular path without intra-abdominal involvement. Necrotic
center right renal excretory mass (5.6 x 6.8 x 4.5cm) without
separation plane with posterior wall in intercostal space D11-D12
or with hepatic segment VI. Suggestive findings renal carcinoma.
(Image 1)
Chest CT: Small blast focus 10° rib arch right.
Bone scintigraphy: linear deposit of moderate intensity in the 10th
right costal arch, compatible with metastatic disease. (Image 2)
Abdominal MRI: Right middle-lower third renal tumor, diameter
6.9cm, suggests clear cell tumor. (Image 3)
Evolution
Four months after the trauma, laparoscopic right radical
nephrectomy. Pathological anatomy: Clear cell renal cancer.
Infiltrate in renal capsule. T1b Nx M1. Subsequently referred to
Nephrology for worsening renal function (creatinine: 1.62mg /
dl, GFR 50) and HTN.
Diagnostics
Incised-penetrating wound on the side right
Clear cell kidney cancer
Stage 3A chronic kidney disease
Treatment
1. Antibiotherapy. Wound drainage. Administered vaccine +
anti-tetanus IG.
2. Progressive mobilization. Local healing and removal of
surgical staples Nephrology consultation
3. Hypo-sodium diet. Water intake> 5 L / day. Avoid NSAIDs
Conclusions
Due to rib trauma, the patient was diagnosed with a clear cell renal
tumor with bone metastases. In 50% of cases, they are diagnosed
fortuitously by carrying out complementary tests for other reasons.
Reference:
Observational, descriptive, retrospective study by reviewing the
clinical history through the SaCyL Medora® program
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