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This pathway provides guidance on the investigation of adult patients with renal colic, including those presenting for the first time and those with recurrent symptoms. Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points. Clicking on the PINK text box will bring up the full text. Kloik relative radiation level RRL of each imaging investigation is displayed in kolim pop up box.
An opacity is present arrow at the left vesico-ureteric junction.
Loin Pain (Renal Colic)
Image 2 Intravenous Pyelography: No stone is visualised, but there is dilatation of the ureter and pelvicalyceal system on the left side. Image 4a and b Computed Tomography: A 10mm calculus is present at the left pelviureteric junction responsible for mild left hydronephrosis and perinephric stranding.
The search methodology is available on request. Radiation Risks of X-rays and Scans. The information contained on this web site is protected by copyright. Please remember that this leaflet is intended as general information only. It is not definitive and The Department of Health, Western Australia can not accept any legal liability arising from its use.
The information is kept as up to date and accurate as possible, but please be warned that it is always subject to change.
To read these files you might need to download Adobe Acrobat Reader. September Date of next review: Images Image Gallery Note: A staghorn calculus is present in the collecting system of the right kidney.
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In selected cases, MRI urography may be then required Conventional IVP can now be considered almost obsolete for the diagnosis of renal colic. However, despite the introduction of low-dose CT protocols, because many patients are young and have recurrent episodes of renal colic, there is concern about cumulative radiation dose. Given that the large majority abbdomen stones pass spontaneously, this would appear to be over-investigation in most patients.
It would be sensible to reserve CT in US positive patients for those in whom intervention is contemplated The recent use of dual-energy CT increases the ability to characterize all ureteral calculi, discriminating uric acid stones from calcium salt stones. askwp
Uric acid stones however, are usually radiolucent and are unlikely to be detected This will enable the progress of the stone to be followed using plain radiography alone. In selected cases, MRI urography may be required References References Date of literature search: September The search methodology is available on request.
Imaging patients with renal colic-consider ultrasound first. Ultrasonography versus aslep tomography for suspected nephrolithiasis.
N Engl J Med. EAU guidelines on diagnosis and conservative management of urolithiasis. Limitations to ultrasound in the detection and measurement adkep urinary tract calculi.
Askep Colik Abdomen
Role of white blood cell and neutrophil counts in predicting spontaneous stone passage in patients with renal colic. Immediate versus deferred radiological investigation after acute renal colic: Scand J Urol Nephrol. Does computed tomographic scan affect diagnosis and management of patients with suspected renal colic? Am J Emerg Med.
Emergency department imaging protocol for suspected acute renal colic: Utility of computed tomography and derivation and validation of a score to identify an emergent outcome in 2, patients with suspected urinary tract stone. Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician. Sonographic diagnosis of symptomatic ureteral calculi: Ultrasound vs CT for the detection of ureteric stones in patients with renal colic.
Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: A prospective study in 66 patients. Diagnosis of acute flank pain: Prevalence of alternative diagnoses in patients with suspected uncomplicated renal colic undergoing computed tomography: Low-dose unenhanced multidetector CT of patients with suspected renal colic.
Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi? J Comput Assist Tomogr. Low dose unenhanced helical computerized tomography for the evaluation of acute flank pain.
Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. View the reference Jain N, Robinson S. Towards evidence based emergency medicine: A clinical effectiveness protocols for imaging in the management of ureteral calculous disease: Prevalence and clinical importance of alternative causes of symptoms using a renal colic computed tomography protocol in patients with flank or back pain and absence of pyuria.
Low-dose and standard-dose unenhanced helical computed tomography for the assessment of acute renal colic: Non-contrast CT at comparable dose to an abdominal radiograph in patients with acute renal colic; impact of iterative reconstruction on image quality and diagnostic performance. Radiation dose index of renal colic protocol CT studies in the United States: Repeated radiological radiation exposure in patients undergoing surgery for urinary tract stone disease in Victoria, Australia.
Radiation dose associated with unenhanced CT for suspected renal colic: Renal stone assessment with dual-energy multidetector CT and advanced postprocessing techniques: Characterization of human renal stones with MDCT: Urinary calculi composed of uric acid, cystine, and mineral salts: View the reference Ekici S, Sinanoglu O. Comparison of conventional radiography combined with ultrasonography versus nonenhanced helical computed tomography in evaluation of patients with renal colic. Does baseline radiography of the kidneys, ureters, and bladder help facilitate stone management in patients presenting to the emergency department with renal colic?
View the reference Teichman JM.
Acute renal colic from ureteral calculus. Imaging of stone disease in pregnancy. Legal Notice Please remember that this leaflet is intended as general information only. Pelvicalyceal Dilatation Image 2 Intravenous Pyelography: Urolithiasis Image 4a and b Computed Tomography: