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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The advantages of nonenhanced helical CT for the diagnosis of ureteral calculi include rapid scan time and patient throughput, safety (no contrast, less radiation), cost-effectiveness, high accuracy, minimal invasiveness, and ability to suggest of alternative diagnoses for flank pain--urologic and otherwise. Size measurement and location in the ureter, the two most important determinants of therapy, are precise with CT. It is particularly good for imaging small or radiolucent calculi, and calculi located at the ureterovesical. Secondary signs of obstruction and the soft-tissue rim sign are additional aids to the routine diagnosis of ureteral calculi. CT numbers indicate the fragility and therefore the likelihood of successful treatment of a calculus. Postprocessing options may help guide management decisions and may help plan interventions. The authors' experience after 30 months of using helical CT exclusively in the work-up of ureteral colic has been extremely favorable. Without hesitation, the authors believe that nonenhanced helical CT is the study of choice for the work-up of ureteral calculi.
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PMID:Helical CT and ureteral colic. 1077 66

The equivalent sensitivity of non-contrast computed tomography (NCCT) and intravenous urography (IVU) in the diagnosis of suspected ureteric colic has been established. Approximately 50% of patients with suspected ureteric colic do not have a nephro-urological cause for pain. Because many such patients require further imaging studies, NCCT may obviate the need for these studies and, in so doing, be more cost effective and involve less overall radiation exposure. The present study compares the total imaging cost and radiation dose of NCCT versus IVU in the diagnosis of acute flank pain. Two hundred and twenty-four patients (157 men; mean age 45 years; age range 19-79 years) with suspected renal colic were randomized either to NCCT or IVU. The number of additional diagnostic imaging studies, cost (IVU A$136; CTU A$173), radiation exposure and imaging times were compared. Of 119 (53%) patients with renal obstruction, 105 had no nephro-urological causes of pain. For 21 (20%) of these patients an alternative diagnosis was made at the initial imaging, 10 of which were significant. Of 118 IVU patients, 28 (24%) required 32 additional imaging tests to reach a diagnosis, whereas seven of 106 (6%) NCCT patients required seven additional imaging studies. The average total diagnostic imaging cost for the NCCT group was A$181.94 and A$175.46 for the IVU group (P < 0.43). Mean radiation dose to diagnosis was 5.00 mSv (NCCT) versus 3.50 mSv (IVU) (P < 0.001). Mean imaging time was 30 min (NCCT) versus 75 min (IVU) (P < 0.001). Diagnostic imaging costs were remarkably similar. Although NCCT involves a higher radiation dose than IVU, its advantages of faster diagnosis, the avoidance of additional diagnostic imaging tests and its ability to diagnose other causes makes it the study of choice for acute flank pain at Christchurch Hospital.
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PMID:Computed tomography versus intravenous urography in diagnosis of acute flank pain from urolithiasis: a randomized study comparing imaging costs and radiation dose. 1153 51

We report a case with spontaneous rupture of the renal pelvis during pregnancy. A 34-year-old Japanese woman was referred at 20 weeks' gestation because of sudden severe right flank pain. She had severe colic pain radiating to the right lower abdomen with percussion tenderness at the right costovertebral angle and was initially suspected to have renal/ureteral calculi. Ultrasonography and intravenous pyelography showed urine extravasating from the renal pelvis, indicating rupture of the right renal pelvis. Immediately following the insertion of a double-J indwelling catheter, her symptoms and perirenal extravasation ceased. She had no further urological problems during pregnancy and a male infant was delivered at 41 weeks' gestation. Cases with spontaneous rupture of the renal pelvis in pregnancy are reviewed.
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PMID:Spontaneous rupture of the renal pelvis during pregnancy: a case report and review of the literature. 1201 80

The differential diagnosis of acute flank pain includes kidney stones, urinary tract infection, dissecting abdominal aortic aneurysm (AAA), arterial or venous compromise of the kidney, renal abscess, renal carcinoma, and papillary necrosis. This is a report of an unusual cause of renal colic: pyelocalyceal diverticulum. Stasis of urine within a diverticulum promotes both calculus formation and urinary tract infection, either of which can lead to colic. Several radiographic findings may suggest a calyceal diverticulum, including, on plain X-ray, a very peripheral or mobile renal calculus, or on intravenous pyelogram, an early filling-defect and delayed or retained filing of a circular or ovoid mass.
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PMID:Pyelocalyceal diverticulum: an unusual cause of acute renal colic. 1221 67

Acute ureteric colic and acute scrotum are among the most commonly seen urological emergencies. We present a case in which a male patient presented with simultaneous right flank pain and ipsilateral scrotal pain.
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PMID:Renal colic and torsion: case report and review. 1251 15

PURPOSE: To evaluate the indications for and the outcomes of extracorporeal shock wave lithotripsy (ESWL) of calyceal stones <5 mm, we prospectively studied a series of 25 patients scheduled for treatment. MATERIALS AND METHODS: Between January 1994 and June 1995, 15 males and 10 females with a mean age of 44 years (median 43; range 4 to 70 years) underwent ESWL of calyceal stones <5 mm using an unmodified HM3 Dornier lithotriptor. RESULTS: Indications for ESWL included 17 patients (68%) suffering from back and flank pain, 3 patients (12%) with gross hematuria and 1 patient (4%) with recurrent episodes of pyelonephritis. Six patients (24%) were asymptomatic. Evaluation 3 months after ESWL revealed that of the 17 patients with flank pain, 13 (76%) had complete resolution of pain and 4 (24%) had partial resolution of pain and there had been no further episodes of gross hematuria or pyelonephritis in the previously affected patients. At 3-month follow-up, of the 31 kidneys treated, plain radiography were available in 29; 20 (69%) were clear and 9 (31%) had small residual fragments. CONCLUSIONS: Calyceal stones <5 mm in maximum diameter can cause significant symptoms such as pain, hematuria and infection and should not be dismissed as inconsequential. When no other obvious cause is apparent, these small stones should be treated with a high likelihood of resolution of symptoms and clearance. ESWL should not be withheld in patients with small asymptomatic calculi who request or require treatment for fear of unexpected colic or stone growth.
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PMID:When is ESWL of small calyceal stones indicated? 1273 21

The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value.
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PMID:Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients. 1281 16

We report the case of a 35-year-old man with no cardiovascular morbidity, presenting with acute flank pain, microscopic haematuria and normal blood pressure. Initially diagnosed as a ureteral colic, the patient was recovered 6 weeks later with severe hypertensive crisis. Further investigations revealed a massive renal infarction secondary to medial fibromuscular dysplasia (FMD). Several aspects of this presentation are intriguing. Renal infarcts are usually seen in older patients having cardiac problems and/or major atheromatous plaques. In addition, FMD is mainly observed in young females and rarely progresses to renal artery occlusion. Furthermore, in this case, FMD remained silent until the acute renal infarction occurred, despite a significant kidney size reduction at the time of diagnosis. Finally, the observation of a delayed hypertensive response to a major renovascular insult provides incentives to discuss possible pathophysiological mechanisms involved in renovascular hypertension.
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PMID:A young man with a renal colic. 1464 2

The role of un enhanced helical CT (UHCT) in the evaluation of acute flank pain suggestive of urinary tract calculi is increasingly appreciated in the last few years. Recent studies have identified the advantages of UHCT in recognizing alternative findings within or outside the urinary tract. These incidental diagnoses on UHCT alter a patient's management and demonstrate the pivotal role of UHCT in rapidly triaging these patients for appropriate management. Clinical impact of incidental diagnoses is maximal in identifying alternate emergent conditions mimicking reno-ureteric colic and in identifying malignancies at an early stage when they are potentially curable.
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PMID:Clinical impact of incidental diagnosis of disease on non-contrast-enhanced helical CT for acute ureteral colic. 1577 Dec 61

A 31 year old man with prosthetic aortic valve replacement presented with sudden onset of colic right flank pain. Analysis of the urine revealed haematuria, and the international normalised ratio was suboptimal. The patient was misdiagnosed as having ureteral colic. On the second day, an ultrasound showed no signs of obstructive uropathy, and there was no evidence of absent function on intravenous pyelogram. Computed tomography with contrast agent was performed and revealed a right renal infarction. Renal angiography demonstrated total occlusion of the right renal artery. Fibrinolytic therapy and angioplasty were unsuccessful. To our knowledge, aortic prosthetic valve thrombus as a source of renal artery embolism mimicking renal colic has not been reported previously. This case underlines the importance of renal colic as a manifestation of renal infarction in patients with prosthetic valves and the need for a high index of suspicion of renal embolism.
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PMID:Renal infarction mimicking renal colic in patient with a prosthetic aortic valve. 1604 72


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