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Contrast-enhanced or noncontrast CT for renal colic: utilizing urinalysis and patient history of urolithiasis to decide.
Desai, Vishal; Cox, Mougnyan; Deshmukh, Sandeep; Roth, Christopher G.
Afiliação
  • Desai V; Department of Radiology, Thomas Jefferson University, 111 S 11th St, Philadelphia, PA, 19107, USA. vishal.desai@jefferson.edu.
  • Cox M; Department of Radiology, Thomas Jefferson University, 111 S 11th St, Philadelphia, PA, 19107, USA.
  • Deshmukh S; Department of Radiology, Thomas Jefferson University, 111 S 11th St, Philadelphia, PA, 19107, USA.
  • Roth CG; Department of Radiology, Thomas Jefferson University, 111 S 11th St, Philadelphia, PA, 19107, USA.
Emerg Radiol ; 25(5): 455-460, 2018 Oct.
Article em En | MEDLINE | ID: mdl-29675722
PURPOSE: In the emergency setting, flank pain commonly leads to a noncontrast CT despite a significant percentage of patients having alternative diagnoses, often difficult to characterize without contrast. We investigated the combined utility of urinalysis and history of urolithiasis in identifying patients who are unlikely to have urolithiasis and may benefit from a contrast-enhanced study. METHODS: Retrospective review of 350 patients from May 2013 to May 2016 was performed for patients in the emergency department with renal colic that underwent noncontrast CT and urinalysis testing. RESULTS: Urolithiasis was present in 282 of the 350 patients reviewed (81%), of which 175 (62%) had an obstructing calculus. RBC-positive urinalysis was present in 231 patients with calculi on CT (sensitivity 82%). Patient history of urolithiasis plus urinalysis had a sensitivity of 94% for detecting calculi. Thirty-five patients (10%) had alternative diagnoses, 33 of which were in patients without obstructing calculi. Sixty-seven patients underwent noncontrast CT despite no history of urolithiasis and a negative urinalysis, 10 of which (15%) had alternative diagnoses. Only three cases in this subset (4%) had nonobstructing 1-2-mm calculi, potentially missed with contrast. In this subset, the projected proportion of optimally characterized cases with intravenous contrast is 96%, compared to 85% without contrast (p = .03). DISCUSSION: Given the high combined sensitivity of urinalysis and patient history (94%), this simple analysis can confidently direct clinicians to a contrast-enhanced CT in "rule-out" cases of flank pain in patients with a negative history and negative urinalysis, particularly given that 15% of these patients had alternative diagnoses.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tomografia Computadorizada por Raios X / Emergências / Urolitíase / Cólica Renal Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Adult / Female / Humans / Male Idioma: En Revista: Emerg Radiol Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tomografia Computadorizada por Raios X / Emergências / Urolitíase / Cólica Renal Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Adult / Female / Humans / Male Idioma: En Revista: Emerg Radiol Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Estados Unidos