Teaching Points
- Abdominal aortic aneurysms (AAA) are commonly misdiagnosed as renal colic. It is important to exclude AAA in older patients, particularly if they demonstrate any haemodynamic instability (including transient hypotension). 29
- Non-contrast enhanced CT scan is the most accurate way of detecting calculi in the renal tract, but a standard dose protocol leads to a significantly higher radiation exposure than a limited intravenous urogram (pyelogram).
- However, an ultra-low dose CT scan gives an acceptably low radiation exposure and is of acceptable accuracy for detecting calculi or most alternative causes of pain.
- In young patients with typical symptoms of renal colic, plain x-ray and ultrasound is an acceptable initial combination.
- In pregnant patients, ultrasound is the investigation of choice.
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