Working Diagnosis:
Grade IV renal and collecting duct injury with perinephric and retroperitoneal hematoma.

Treatment:
The Interventional Radiology and Urology teams determined that neither angioembolization nor acute urologic intervention was required. The patient remained hemodynamically stable throughout hospitalization.

His hematuria improved, and serial abdominal examinations remained stable during the first 72 hours of inpatient observation. Repeat CT with contrast and delayed-phase imaging obtained 48 hours after injury demonstrated resolution of the urinary leak, a stable left renal laceration, reduction in the perinephric hematoma, and no active contrast extravasation.

He tolerated a regular diet and was discharged home.

Outcome:
At the 3-week follow-up visit, the patient reported no pain or hematuria.

At 6 weeks, a CT urogram with and without contrast and delayed-phase imaging demonstrated improved hypoattenuation at the prior laceration site, no contrast extravasation, and near-complete resolution of the perinephric hematoma. Case Photo #3 Case Photo #4

He was cleared for workouts but was advised by Urology to avoid full-contact sports for 3 to 4 months.

Author's Comments:
Traumatic renal injuries are rare in football but are reported to occur approximately ten times more frequently during games than practices.1 Kidney contusions (Grade I) are the most common renal injuries, followed by lacerations (Grades II-V).1

Per the American Association for the Surgery of Trauma (AAST), injury grading is based on the highest severity identified by imaging, surgery, or pathology.2 Conservative management is preferred in the absence of hemodynamic instability, large perirenal hematoma (>4 cm), vascular contrast extravasation associated with deep or complex renal lacerations (Grade III-V), or penetrating injury with active bleeding. Otherwise, angioembolization and/or surgical exploration may be required.3

Editor's Comments:
Although solid organ injuries are rare in American football, they remain an important diagnostic consideration in athletes presenting with acute abdominal pain following trauma. Initial sideline evaluation may include point-of-care ultrasonography when available, but this should not delay definitive care.

Progressive abdominal pain, peritoneal signs, hemodynamic instability, and/or hematuria warrant prompt referral to an emergency department capable of advanced imaging and trauma evaluation.

References:
1. Brophy RH, Gamradt SC, Barnes RP, Powell JW, DelPizzo JJ, Rodeo SA, Warren RF. Kidney injuries in professional American football: implications for management of an athlete with 1 functioning kidney. Am J Sports Med. 2008 Jan;36(1):85-90. doi: 10.1177/0363546507308940. Epub 2007 Nov 6. PMID: 17986635.

2. Keihani S, Tominaga GT, Matta R, Gross JA, Cribari C, Kaups KL, Crandall M, Kozar RA, Werner NL, Zarzaur BL, Coburn M, Myers JB. Kidney organ injury scaling: 2025 update. J Trauma Acute Care Surg. 2025 Mar 1;98(3):448-451. doi: 10.1097/TA.0000000000004509. Epub 2025 Jan 20. PMID: 39836096.

3. Morey AF, Broghammer JA, Hollowell CMP, McKibben MJ, Souter L. Urotrauma Guideline 2020: AUA Guideline. J Urol. 2021 Jan;205(1):30-35. doi: 10.1097/JU.0000000000001408. Epub 2020 Oct 14. PMID: 33053308.

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