title: Alternate or additional findings to stone disease on unenhanced computerized tomography for acute flank pain can impact management.
abstract: OBJECTIVE
  We evaluated the incidence and clinical relevance of alternate or additional findings on unenhanced CT in patients with acute flank pain and suspected urinary calculi.
  
  
  METHODS
  A consecutive series of 1,500 patients underwent unenhanced CT due to acute flank pain. The absence or presence of urinary tract calculi and their localization were recorded. Alternate or additional CT findings were classified according to whether they required immediate or deferred treatment, or were of little or no clinical importance.
  
  
  RESULTS
  Of the 1,500 patients 1,035 (69%) had urinary tract calculi, including 309 (30%) with nephrolithiasis, 377 (36%) with ureterolithiasis and 349 (34%) with the 2 conditions. Urolithiasis alone was found in 331 of these patients (32%) and additional pathological conditions were noted in 704 (68%). Of all patients 1,064 (71%) had other or additional CT findings. Of all patients 207 (14%) had nonstone related CT findings requiring immediate or deferred treatment, 464 (31%) had pathological conditions of little clinical importance and 393 (26%) had pathological conditions of no clinical relevance. CT was normal in 105 of all patients (7%).
  
  
  CONCLUSIONS
  Unenhanced CT in patients with acute flank pain allows the accurate diagnosis of urinary stone disease and it can also provide further important information leading to emergency or deferred treatment in a substantial number of patients.
authors.affiliation: Institute of Diagnostic Radiology, University of Bern, Bern, Switzerland.
authors.forename: Hanno
authors.initials: H
authors.lastname: Hoppe
authors.forename: Roger
authors.initials: R
authors.lastname: Studer
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
authors.forename: Peter
authors.initials: P
authors.lastname: Vock
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
authors.forename: Harriet C
authors.initials: HC
authors.lastname: Thoeny
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D021501:Flank Pain / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D007669:Kidney Calculi / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014514:Ureteral Calculi / Q000150:complications* / Q000000981:diagnostic imaging*