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THE VALUE OF UNENHANCED HELICAL COMPUTERIZED TOMOGRAPHY IN THE MANAGEMENT OF ACUTE FLANK PAIN

1998; Lippincott Williams & Wilkins; Volume: 159; Issue: 3 Linguagem: Inglês

10.1016/s0022-5347(01)63714-5

1527-3792

Neal C. Dalrymple, M Verga, Kevin R. Anderson, Peter F. Bove, Anne M. Covey, Arthur T. Rosenfield, Robert C. Smith,

Pelvic and Acetabular Injuries

No AccessJournal of UrologyClinical Urology: Original Articles1 Mar 1998THE VALUE OF UNENHANCED HELICAL COMPUTERIZED TOMOGRAPHY IN THE MANAGEMENT OF ACUTE FLANK PAIN NEAL C. DALRYMPLE, MARCO VERGA, KEVIN R. ANDERSON, PETER BOVE, ANNE M. COVEY, ARTHUR T. ROSENFIELD, and ROBERT C. SMITH NEAL C. DALRYMPLENEAL C. DALRYMPLE More articles by this author , MARCO VERGAMARCO VERGA More articles by this author , KEVIN R. ANDERSONKEVIN R. ANDERSON More articles by this author , PETER BOVEPETER BOVE More articles by this author , ANNE M. COVEYANNE M. COVEY More articles by this author , ARTHUR T. ROSENFIELDARTHUR T. ROSENFIELD More articles by this author , and ROBERT C. SMITHROBERT C. SMITH More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63714-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute flank pain and suspected ureteral obstruction. Materials and Methods: During a 25-month interval 417 patients with acute flank pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome. Results: Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone extraction in 7, additional imaging (excretory urography) was performed in only 1. Additional imaging studies generated by CT were done in 3 cases in which the dictated reports were indeterminate for ureteral stones, including negative excretory urography in 2 and retrograde urography in 1. In 1 patient in whom CT misdiagnosed a ureteral stone unnecessary retrograde urography revealed the calcification to be a gonadal vein phlebolith. Seven patients with false-negative examinations reported spontaneous stone passage with no complications. Conclusions: Unenhanced helical CT accurately determines the presence or absence of ureterolithiasis in patients with acute flank pain. CT precisely identifies stone size and location. When ureterolithiasis is absent, other causes of acute flank pain can be identified. In most cases additional imaging is not required. References 1 : Acute flank pain: comparison of unenhanced-enhanced CT and intravenous urography. Radiology1995; 194: 789. Google Scholar 2 : Diagnosis of acute flank pain: value of unenhanced helical CT. AJR1996; 166: 97. Google Scholar 3 : Detection of ureteral calculi in patients with suspected renal colic: value of reformatted noncontrast helical CT. AJR1995; 165: 509. Google Scholar 4 : Unenhanced helical CT of ureteral stones: incidence of associated urinary tract findings. AJR1996; 166: 1319. Google Scholar 5 : Acute ureteral obstruction: value of secondary signs on helical unenhanced CT. AJR1996; 167: 1109. 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Volume 159Issue 3March 1998Page: 735-740 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information NEAL C. DALRYMPLE More articles by this author MARCO VERGA More articles by this author KEVIN R. ANDERSON More articles by this author PETER BOVE More articles by this author ANNE M. COVEY More articles by this author ARTHUR T. ROSENFIELD More articles by this author ROBERT C. SMITH More articles by this author Expand All Advertisement PDF DownloadLoading ...