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  #1  
Old 01-26-2011
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Kidney Initial imaging choice in suspected renal colic

What is the initial test of choice in suspected renal colic
Is it KUB or Ultrasound?
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Old 02-03-2011
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u first start with KUB
if no Dx can be established based on KUB
then u go for ultrasound
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Old 02-05-2011
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I am not sure if this is the first option (doing KUB)

When you come across a pt w/ renal colic you have no idea what's causing this (could be stone ħradiopaque, abscess, cancer, trauma). Also, you don't know if this pt has obstruction (urinalysis and BUN/Cr won't help you if only 1 ureter is obstructed).

KUB: Will show if there is a stone or not. End of discussion.

U/S: Might show stone, but also will assess if there is dilation, scars, masses, perinephric or nephric pathology.

Thus I'd go for Ultrasound as a first evaluation, tied with UA, and bloodwork
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Old 02-11-2011
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Idea! Update

USMLEWORLD info I've recently come across mentions that the best initial modality is neither KUB nor US, but non-contrast spiral CT. The explanation writer argues that KUB can miss radiolucent stones (15% of stones) and small stones. US can also miss small stones, although it would be the only modality that's safe to order in pregnant patients.
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Old 02-11-2011
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Quote:
Originally Posted by Haisook View Post
USMLEWORLD info I've recently come across mentions that the best initial modality is neither KUB nor US, but non-contrast spiral CT. The explanation writer argues that KUB can miss radiolucent stones (15% of stones) and small stones. US can also miss small stones, although it would be the only modality that's safe to order in pregnant patients.
Are you sure that CT is not the most specific? I doubt that we should do a CT in all of our pts w/ a renal colic...
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Old 02-11-2011
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Quote:
Originally Posted by tkourkou View Post
Are you sure that CT is not the most specific? I doubt that we should do a CT in all of our pts w/ a renal colic...
Here's the exact terms used: the question asked for the best test to diagnose the condition. In the explanation, it's mentioned that it's the first-line modality and is quick to perform. In the educational objective, it said it's the imaging modality of choice for diagnosis.

The question ID is 2298.
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Old 02-11-2011
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Quote:
Originally Posted by Haisook View Post
Here's the exact terms used: the question asked for the best test to diagnose the condition. In the explanation, it's mentioned that it's the first-line modality and is quick to perform. In the educational objective, it said it's the imaging modality of choice for diagnosis.

The question ID is 2298.
I will definitely check it out. Thanks Haisook!
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Old 03-29-2011
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I just came across this question! And I have to say that in Kaplan Qbank they state the same... When you have renal colic do NON-contrast CT scan first...
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  #9  
Old 03-29-2011
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Default renal stone

Well...CT means radiation.....
renal stone can be diagnosed by history and PE + inv

summer, colic like pain radiating loin to groin
no fever

KUB is the most quick inv u can do.
If u want specific, usg because even rediolucent calculi will be seen

I would say KUB

Can anyone check that for sure please
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Old 03-29-2011
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Default USG

USG is not quick to perform
It requires a full bladder preparation and no solid food
Right?
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Old 03-29-2011
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Quote:
Originally Posted by Haisook View Post
What is the initial test of choice in suspected renal colic
Is it KUB or Ultrasound?
CT scan without contrast is the BEST choice to make an accurate diagnosis , the stone is visible 100% , disadvantage (radiation, can't be done in case of pregnancy)

ultrasound is a good choice, but limited in case of small stone or gas (higher in renal colic)

KUB is a good choice but causes radiations and also very limited unless the stone is big and opaque

in my opinion first episode of renal colic : CT scan without contrast best for DC accuracy

but the first line in case of any abdominal pain is KUB anyway
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Old 03-29-2011
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Quote:
Originally Posted by Oodesh View Post
USG is not quick to perform
It requires a full bladder preparation and no solid food
Right?
no it doesn't require bladder preparation or no solid food
ultrasound require that but not in case of emergency like a renal colic
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Old 03-29-2011
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definitely not USG.... it doesnt detect stones... just looks at the hydronephrosis or the dilated calyceal system....

according to me after reading goljan patho its gotta be CT scan...
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Old 03-29-2011
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Quote:
Originally Posted by gargabhi2 View Post
definitely not USG.... it doesnt detect stones... just looks at the hydronephrosis or the dilated calyceal system....

according to me after reading goljan patho its gotta be CT scan...
USG does detect stones, the limit is when the stones are in the ureters or if there is a lot of gas........... it's definitely the exam to do if yo have a pregnant women with renal colic for example
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Old 03-29-2011
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Well, to sum things up for the exam:

- You suspect renal colic: initial test is non-contrast spiral CT.
- If the patient is pregnant: do US instead.
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Old 03-30-2011
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pls note that the next best step in this case is:
analgesics before the diagnostic test....
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