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Soru

Zorluk: KolayOrdering Imaging Studies

A 38-year-old man presents to the emergency department complaining of sudden-onset, severe right flank pain that started two hours ago. The pain radiates to his right groin and is associated with nausea and two episodes of vomiting. He is unable to find a comfortable position and is pacing around the examination room. His temperature is 37.1°C (98.8°F), blood pressure is 155/92 mmHg, pulse is 112/min, and respiratory rate is 18/min. Physical examination reveals right costovertebral angle tenderness but no abdominal rebound or guarding. Laboratory studies show a serum creatinine of 0.9 mg/dL. Urinalysis is positive for gross blood, but negative for leukocyte esterase and nitrites. Which of the following is the most appropriate initial imaging study for this patient?

  1. Non-contrast computed tomography of the abdomen and pelvisCevap
  2. B
    Computed tomography of the abdomen and pelvis with intravenous contrast
  3. C
    Renal and bladder ultrasonography
  4. D
    Plain radiography of the kidneys, ureters, and bladder
  5. E
    Magnetic resonance imaging of the abdomen and pelvis

Cevap

Non-contrast computed tomography of the abdomen and pelvis
The correct answer is a non-contrast CT of the abdomen and pelvis. This patient presents with classic signs and symptoms of nephrolithiasis (renal colic), including colicky flank pain radiating to the groin, inability to sit still, and hematuria. In the general, non-pregnant adult population, a non-contrast CT of the abdomen and pelvis is the gold standard imaging modality. It has excellent sensitivity and specificity, can detect radiolucent stones (which plain films miss), and accurately determines stone size and location, which is critical for guiding management.

Adım Adım Çözüm

1
Identify the primary clinical syndrome.
The patient has sudden-onset, severe unilateral flank pain radiating to the groin, accompanied by pacing, costovertebral angle tenderness, and hematuria.
Recognizing this classic presentation establishes a high pretest probability for nephrolithiasis (renal colic).
2
Determine the optimal diagnostic imaging for the suspected condition.
Guidelines recommend non-contrast CT of the abdomen and pelvis for a non-pregnant adult.
Non-contrast CT provides the highest sensitivity and specificity for visualizing both radiopaque and radiolucent stones, while measuring stone size and detecting hydronephrosis.

Anahtar Kavram

The most appropriate initial imaging study for suspected nephrolithiasis in a non-pregnant adult is a non-contrast CT scan of the abdomen and pelvis.
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