Ultrasonography of Acute Flank Pain: a Focus on Renal Stones and Acute Pyelonephritis

Overview

Journal Ultrasonography

Date 2018 Feb 1

PMID 29382187

Citations 4

Authors

Ki Choon Sim

Affiliations

Soon will be listed here.

Abstract

Ultrasonography is a useful tool for the differential diagnosis of acute flank pain. Renal stones appear as a focal area of echogenicity with acoustic shadowing on ultrasonography. In acute pyelonephritis (APN), the kidneys may be enlarged and have a hypoechoic parenchyma with loss of the normal corticomedullary junction. However, clinical and laboratory correlations are essential for the diagnosis of renal stones and APN through imaging studies. This review describes the typical ultrasonography features of renal stones and APN. Moreover, in daily practice, cross-sectional imaging is essential and widely used to confirm renal stones and APN and to differentiate them from other diseases causing flank pain. Other diseases causing acute flank pain are also described in this review.

Citing Articles

Unilateral renal cortical necrosis.

Shahzad V, McDonald K, Murphy R, OMeara Y Radiol Case Rep. 2024; 19(6):2483-2486.

PMID: 38577129 PMC: 10992279. DOI: 10.1016/j.radcr.2024.02.108.

Best Imaging Method for Detection of Renal Stones.

Akhavan Sepahi M, Mosavimovahed M Med J Islam Repub Iran. 2022; 35:160.

PMID: 35341086 PMC: 8932211. DOI: 10.47176/mjiri.35.160.

Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study.

Fahimi D, Khedmat L, Afshin A, Noparast Z, Jafaripor M, Beigi E BMC Infect Dis. 2021; 21(1):189.

PMID: 33602159 PMC: 7890627. DOI: 10.1186/s12879-021-05887-1.

Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department.

Brown N, Petersen P, Kinas D, Newberry M Case Rep Emerg Med. 2019; 2019:6903193.

PMID: 31565445 PMC: 6745128. DOI: 10.1155/2019/6903193.

References

Song Y, Hernandez N, Gee M, Noble V, Eisner B . Can ureteral stones cause pain without causing hydronephrosis?. World J Urol. 2015; 34(9):1285-8. DOI: 10.1007/s00345-015-1748-4. View

Dillman J, Kappil M, Weadock W, Rubin J, Platt J, Dipietro M . Sonographic twinkling artifact for renal calculus detection: correlation with CT. Radiology. 2011; 259(3):911-6. DOI: 10.1148/radiol.11102128. View

Boyce A, Shawker T, Hill S, Choyke P, Hill M, James R . Ultrasound is superior to computed tomography for assessment of medullary nephrocalcinosis in hypoparathyroidism. J Clin Endocrinol Metab. 2013; 98(3):989-94. PMC: 3590469. DOI: 10.1210/jc.2012-2747. View

Aslaksen A, Gothlin J . Ultrasonic diagnosis of ureteral calculi in patients with acute flank pain. Eur J Radiol. 1990; 11(2):87-90. DOI: 10.1016/0720-048x(90)90153-3. View

Riehl J, Schneider B, Bongartz D, Sieberth H . Medullary nephrocalcinosis: sonographic findings in adult patients. Bildgebung. 1995; 62(1):18-22. View

Sandler C, Amis Jr E, Bigongiari L, Bluth E, Bush Jr W, Choyke P . Imaging in acute pyelonephritis. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000; 215 Suppl:677-81. View

Fernbach S, Maizels M, Conway J . Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993; 23(6):478-80. DOI: 10.1007/BF02012459. View

Tamm E, Silverman P, Shuman W . Evaluation of the patient with flank pain and possible ureteral calculus. Radiology. 2003; 228(2):319-29. DOI: 10.1148/radiol.2282011726. View

Tarzamni M, Sobhani N, Nezami N, Ghiasi F . Bilateral parapelvic cysts that mimic hydronephrosis in two imaging modalities: a case report. Cases J. 2008; 1(1):161. PMC: 2577646. DOI: 10.1186/1757-1626-1-161. View

10.

Moore C, Scoutt L . Sonography first for acute flank pain?. J Ultrasound Med. 2012; 31(11):1703-11. DOI: 10.7863/jum.2012.31.11.1703. View

11.

Hill M, Rich J, Mardiat J, Finder C . Sonography vs. excretory urography in acute flank pain. AJR Am J Roentgenol. 1985; 144(6):1235-8. DOI: 10.2214/ajr.144.6.1235. View

12.

Gaspari R, Horst K . Emergency ultrasound and urinalysis in the evaluation of flank pain. Acad Emerg Med. 2005; 12(12):1180-4. DOI: 10.1197/j.aem.2005.06.023. View

13.

Craig W, Wagner B, Travis M . Pyelonephritis: radiologic-pathologic review. Radiographics. 2008; 28(1):255-77. DOI: 10.1148/rg.281075171. View

14.

Kamaya A, Tuthill T, Rubin J . Twinkling artifact on color Doppler sonography: dependence on machine parameters and underlying cause. AJR Am J Roentgenol. 2002; 180(1):215-22. DOI: 10.2214/ajr.180.1.1800215. View

15.

Luchs J, Katz D, Lane M, Mellinger B, Lumerman J, Stillman C . Utility of hematuria testing in patients with suspected renal colic: correlation with unenhanced helical CT results. Urology. 2002; 59(6):839-42. DOI: 10.1016/s0090-4295(02)01558-3. View

16.

Stunell H, Buckley O, Feeney J, Geoghegan T, Browne R, Torreggiani W . Imaging of acute pyelonephritis in the adult. Eur Radiol. 2006; 17(7):1820-8. DOI: 10.1007/s00330-006-0366-3. View