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Is There a Better Way to Image Renal Colic?

September 10, 2019

Written by Clay Smith

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Ultrasound appears to be best for most renal colic (RC) clinical scenarios. CT is best in older patients (especially with no stone history), those with tenderness on abdominal exam, or those with uncontrolled pain.

Why does this matter?
CT has become the default for imaging RC, but it hasn’t impacted any patient-centered outcomes. Is there a better way to image these patients?

Making patients glow from radiation isn’t nice
This was an expert panel of emergency physicians, urologists, and radiologists. They reviewed 232 articles together to determine optimal imaging in different clinical scenarios. Here are the high points. The experts agreed that:

  • An ultrasound approach (POCUS or radiology performed), without CT, was warranted in young patients with new-onset RC and controlled pain, those with prior stones that have passed, pregnant patients, and even patients with mild hydronephrosis on ultrasound.

  • When CT is obtained, it should be reduced dose.

  • A CT-first approach was recommended by these experts in elderly patients (i.e. 75 years) regardless of stone history, especially those with tenderness on abdominal exam; patients ≥55y with apparent RC and no history of stone; patients with uncontrolled pain; even young patients with no stone history and abdominal tenderness on exam.

The take home point is that in most clinical scenarios, leading with ultrasound, either POCUS or in radiology, is a safe bet that drastically reduces our patients’ exposure to radiation.

Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus. Ann Emerg Med. 2019 Aug 1. pii: S0196-0644(19)30344-0. doi: 10.1016/j.annemergmed.2019.04.021. [Epub ahead of print]

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Reviewed by Thomas Davis

What are your thoughts?