Impact in the Emergency Department of Unenhanced CT on Diagnostic Confidence and Therapeutic Efficacy in Patients with Suspected Renal Colic: A Prospective Survey

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Impact in the Emergency Department of Unenhanced CT on Diagnostic Confidence and Therapeutic Efficacy in Patients with Suspected Renal Colic

A Prospective Survey

Simeon Abramson¹, Natalie Walders², Kimberly E. Applegate¹, Robert C. Gilkeson¹ and Mark R. Robbin¹

^¹ Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106.
^² Department of Psychology, Case Western Reserve University, Cleveland, OH 44106.

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Fig. 1. —Bar chart shows that diagnostic confidence of clinicians regarding urinary calculi varied before CT. Largest frequencies were 41-60% (n = 30) and 71-90% (n = 35). Diagnostic certainty of calculi after CT showed movement toward either less than or equal to 10% (n = 25, 27%) or greater than or equal to 91% (n = 51, 55%). Note that 100% indicates 100% confidence in diagnosis of calculi, and 0% indicates 100% confidence in alternative diagnosis or normal study.

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Fig. 2A. —33-year-old woman with left flank pain who would have been discharged initially before CT and, instead, was admitted to hospital for therapeutic procedure after CT. Axial CT scan reveals left hydroureter (arrow).

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Fig. 2B. —33-year-old woman with left flank pain who would have been discharged initially before CT and, instead, was admitted to hospital for therapeutic procedure after CT. Five-millimeter caudal CT scan shows large left ureteral calculus (arrow).

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Fig. 2C. —33-year-old woman with left flank pain who would have been discharged initially before CT and, instead, was admitted to hospital for therapeutic procedure after CT. Coronal reconstructed CT scan shows large ureteral calculus (arrow) with proximal hydroureter and hydronephrosis.

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Fig. 3. —Axial CT scan in 45-year-old woman with abdominal pain shows large fluid-filled appendix (arrow) with associated appendicolith (arrowhead). Acute appendicitis was confirmed at surgery.

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Fig. 4. —46-year-old woman with flank pain, hematuria, and no history of trauma. Axial CT scan shows large spontaneous retroperitoneal hemorrhage (arrows). Patient was admitted to hospital for appropriate treatment rather than being discharged.

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Fig. 5A. —39-year-old woman with hematuria and left flank pain. Axial CT scan shows moderate left perirenal inflammatory changes (arrows).

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Fig. 5B. —39-year-old woman with hematuria and left flank pain. Axial CT scan at level of bladder reveals 2-mm left ureterovesical junction stone with surrounding edema (arrow). We discharged patient. CT findings obviated necessity for emergency urology consultation.

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Fig. 6A. —76-year-old woman with left flank pain. Axial CT scan reveals ipsilateral flattening of left bladder wall (arrows).

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Fig. 6B. —76-year-old woman with left flank pain. Five-millimeter caudal CT scan shows 3-mm left ureterovesical junction calculus (arrow). Urology consultation was not needed after CT, and patient was discharged.

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Fig. 7. —59-year-old woman with abdominal pain. Axial CT image shows 4-mm right ureteral calculus with circumferential rim of soft tissue—"tissue rim sign" (arrow).

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