title: Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications.
abstract: OBJECTIVE
  To evaluate the role of multidetector computed tomography (MDCT) in recognizing the complications of extracorporeal shock wave lithotripsy (ESWL) and providing a prognostic grading system for the therapeutic approach.
  
  
  METHODS
  A total of 43 patients who underwent ESWL because of urinary stone disease were assessed by 320-row MDCT examination before and after ESWL. Pre-ESWL CT unenhanced scans were performed for diagnosing stone disease. Post-ESWL CT scans were acquired before and after intravenous injection of contrast medium searching for peri-renal fluid collection or hyper-density, pyelic or ureteral wall thickening, blood clots in the urinary tract, peri- or intra-renal hematoma or abscess, active bleeding. A severity grading system of ESWL complications was established.
  
  
  RESULTS
  Patients were affected by renal (n = 36) or ureteral (n = 7) lithiasis. Post-ESWL CT examination detected small fluid collections and hyper-density of peri-renal fat tissue in 35/43 patients (81%), pyelic or ureteral wall thickening in 2/43 (4%), blood clots in the urinary tract in 9/43 (21%), renal abscesses or hematomas with a diameter of <2 cm in 10/43 (23%), large retroperitoneal collections in 3/43 (7%), active bleeding from renal vessels in 1/43 (2%). Mild complications were found in 30 cases; moderate in 9; severe in 4. The therapeutic choice was represented by clinical follow-up (n = 20), clinical and CT follow-up (n = 10), ureteral stenting (n = 9), drainage of large retroperitoneal collections (n = 3), and arterial embolization (n = 1).
  
  
  CONCLUSIONS
  MDCT plays a crucial role in the diagnosis of urolithiasis and follow-up of patients treated with ESWL recognizing its complications and providing therapeutic and prognostic indications.
authors.affiliation: Department of Interdisciplinary Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Telegrafo
authors.affiliation: Department of Interdisciplinary Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Davide Antonio
authors.initials: DA
authors.lastname: Carluccio
authors.affiliation: Department of Interdisciplinary Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Leonarda
authors.initials: L
authors.lastname: Rella
authors.affiliation: Department of Interdisciplinary Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Amato Antonio Stabile
authors.initials: AA
authors.lastname: Ianora
authors.affiliation: Department of Interdisciplinary Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Angelelli
authors.affiliation: Department of Interdisciplinary Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschetta
keywords: Complications; computed tomography; extracorporeal shock wave lithotripsy; urolithiasis