Background: The patient was an 18-year-old male high school football player, who had no notable past medical history. He was hit on his left side in the first quarter but was able to complete the game. About 30 minutes after the game, the patient complained of signifi cant pain on his left lower anterolateral thorax. The patient described pain as constant, aching, and a 9/10 on a pain scale. The patient also described associated shortness of breath and pleuritic chest pain. Patients' blood pressure currently was 142/96 and pulse was 80 beats per minute.The athletic trainer found tenderness to palpation in the left upper quadrant but did not have any guarding or rebound tenderness. The patient reported that he had not urinated since approximately five hours before the evaluation. During the actual evaluation, the patient was able to produce urine and reported hematuria to the athletic trainer. Differential Diagnosis:Differential diagnosis included left renal trauma, splenic trauma, left costal fracture and associated pneumothorax, intercostal and abdominal musculature contusions, and a muscular strain. Treatment: After evaluation by athletic trainer, the patient was referred to the emergency department. Initial assessment by emergency departments physician revealed findings consistent with what the athletic trainer found, and most of his systems were functioning normally. Regarding the specific area of injury, the emergency room physicians found his abdomen to be soft and nondistended with no ecchymoses. He was still point tender to palpation over left upper quadrant as well as the left anterior and lateral lower thorax. His current blood pressure was 138/72 and pulse was 90 beats per minute. In the emergency department, the physician ordered for the following diagnostic tests: Focused Assessment with Sonography for Traumaexam, Complete Blood Count, Comprehensive Metabolic Panel, and Urinalysis. All tests were within normal limits except the urinalysis, which revealed a red blood cell count that wasgreater than 180. A CT scan of the thorax/pelvis/abs showed a left renal laceration >1cm in depth with surrounding hemorrhage; Gerota's fascia was intact and no active blood extravasation or urine lead identified.This resulted in the final diagnosis of a Grade 4 Kidney Laceration. Uniqueness: This case is so unique because renal trauma accounts for only 1-5% of sports trauma cases and a grade 4 kidney laceration specifically only accounts for 10% of all renal injuries. In addition, this type of injury usually occurs during high intensity motor crashes and assaults and not necessarily from a tackle. In addition, this specific injury could have gone undiagnosed since it lacked initial pain to the patient. Conclusions: Ultimately, this case illustrates that internal injuries, although rare are still possible especially in collision sports. This spotlights the need for athletic trainers to be prepared to handle both emergency and nonemergency situations. Moreover, this case reinforces the need for athletic trainers to be able to recognize the signs and symptoms of internal injuries, so that they can be proficient with sideline evaluations and recognition of deteriorating conditions because any potential error in evaluation could be detrimental.
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