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Mimics of Renal Colic: Alternative Diagnoses at Unenhanced Helical CT¹

¹ From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110. Presented as an education exhibit at the 2003 RSNA scientific assembly. Received February 9, 2004; revision requested March 4 and received April 5; accepted April 14. All authors have no financial relationships to disclose. Address correspondence to S.B. (e-mail: bhallas@mir.wustl.edu).

During the past decade, unenhanced computed tomography (CT) has become the standard of reference in the detection of urinary calculi owing to its high sensitivity (>95%) and specificity (>98%) in this setting. Numerous diseases may manifest as acute flank pain and mimic urolithiasis. Up to one-third of unenhanced CT examinations performed because of flank pain may reveal unsuspected findings unrelated to stone disease, many of which can help explain the patient’s condition. Alternative diagnoses are most commonly related to gynecologic conditions (especially adnexal masses) and nonstone genitourinary disease (eg, pyelonephritis, renal neoplasm), closely followed by gastrointestinal disease (especially appendicitis and diverticulitis). Hepatobiliary, vascular, and musculoskeletal conditions may also be encountered. Vascular causes of acute flank pain must always be considered, since these constitute life-threatening emergencies that may require the intravenous administration of contrast material for diagnosis. Radiologists must be familiar with the typical findings of urinary stone disease at unenhanced CT, as well as the spectrum of alternative diagnoses that may be detected with this modality, to accurately diagnose the source of flank pain.

© RSNA, 2004

Index Terms: Computed tomography (CT), helical • Gastrointestinal tract, abnormalities, 70.12115 • Genitourinary system, abnormalities, 80.12115 Ureter, calculi, 82.81

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Invited Commentary • Authors' Response

Douglas S. Katz, Monica Jain, Michael J. Lane, Evan M. Meiner, Sanjeev Bhalla, Christine O. Menias, and Creed M. Rucker
RadioGraphics 2004 24: S28-S33. [Full Text] [PDF]

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