caa a22 4500 606172084 CHVBK 20210128100726.0 cr unu---uuuuu 210128e20150401xx s 000 0 eng 10.1007/s10140-014-1259-4 doi (NATIONALLICENCE)springer-10.1007/s10140-014-1259-4 Limited added utility of performing follow-up contrast-enhanced CT in patients undergoing initial non-enhanced CT for evaluation of flank pain in the emergency department [Elektronische Daten] [Monica Agarwal, Robin Levenson, Bettina Siewert, Marc Camacho, Vassilios Raptopoulos] In our emergency department (ED), patients with flank pain often undergo non-enhanced computed tomography (NECT) to assess for nephroureteral (NU) stone. After immediate image review, decision is made regarding need for subsequent contrast-enhanced CT (CECT) to help assess for other causes of pain. This study aimed to review the experience of a single institution with this protocol and to assess the utility of CECT. Over a 6month period, we performed a retrospective analysis on ED patients presenting with flank pain undergoing CT for a clinical diagnosis of nephroureterolithiasis. Patients initially underwent abdominopelvic NECT. The interpreting radiologist immediately decided whether to obtain a CECT to evaluate for another etiology of pain. Medical records, CT reports and images, and 7-day ED return were reviewed. CT diagnoses on NECT and CECT were compared. Additional information from CECT and changes in management as documented in the patient's medical record were noted. Three hundred twenty-two patients underwent NECT for obstructing NU stones during the study period. Renal or ureteral calculi were detected in 143/322 (44.4%). One hundred fifty-four patients (47.8%) underwent CECT. CECT added information in 17/322 cases (5.3%) but only changed management in 6/322 patients (1.9%). In four of these patients with final diagnosis of renal infarct, splenic infarct, pyelonephritis and early acute appendicitis in a thin patient, there was no abnormality on the NECT (4/322 patients, 1.2%). In the remaining 2 patients, an abnormality was visible on the NECT. In patients presenting with flank pain with a clinical suspicion of nephroureterolithiasis, CECT may not be indicated. While CECT provided better delineation of an abnormality in 5.3% of cases, changes in management after CECT occurred only in 2%. This included 1% of patients in whom a diagnosis of organ infarct, pyelonephritis or acute appendicitis in a thin patient could only be made on CECT. American Society of Emergency Radiology, 2014 Emergency department (ED) nationallicence Nephroureteral nationallicence Calculi nationallicence Nephroureterolithiasis nationallicence Stone nationallicence Agarwal Monica Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut Levenson Robin Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut Siewert Bettina Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut Camacho Marc Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut Raptopoulos Vassilios Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut Emergency Radiology Springer Berlin Heidelberg 22/2(2015-04-01), 109-115 1070-3004 22:2<109 2015 22 10140 https://doi.org/10.1007/s10140-014-1259-4 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10140-014-1259-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Agarwal Monica Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut NATIONALLICENCE 700 1- Levenson Robin Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut NATIONALLICENCE 700 1- Siewert Bettina Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut NATIONALLICENCE 700 1- Camacho Marc Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut NATIONALLICENCE 700 1- Raptopoulos Vassilios Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02215, Boston, MA, USA aut NATIONALLICENCE 773 0- Emergency Radiology Springer Berlin Heidelberg 22/2(2015-04-01), 109-115 1070-3004 22:2<109 2015 22 10140