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Pain Imaging pp 275-302 | Cite as

Imaging of Renal Colic

  • Paola MartinganoEmail author
  • Marco F. M. Cavallaro
  • Fulvio Stacul
  • Maria Assunta Cova
Chapter

Abstract

Renal colic indicates a type of abdominal pain due to urinary tract obstruction, commonly caused by urinary stones. The classic presentation of renal colic is the sudden onset of severe loin pain, but depending on the site of obstruction, the pain will radiate to the flank, groin, and testes or labia majora. Unfortunately, symptoms due to many other abdominal diseases could be indistinguishable from renal colic, and therefore emergency imaging in patients with suspected renal colic is necessary to rule out other clinical conditions, either renal diseases or gynecologic, gastrointestinal, pancreatic, hepatobiliary, vascular, and musculoskeletal conditions. In this setting, imaging is required to allow rapid diagnosis, to guide patient management, and to evaluate active treatment complications.

Abdominal plain films recognize a urinary stone for its opacity, but only 48–63% of urinary stones are visible. Intravenous urography nowadays has been almost everywhere substituted by ultrasound or computed tomography. Ultrasonography is often performed as an initial imaging modality in case of abdominal pain evaluation since it is safe, noninvasive, repeatable, and quite low expensive. It directly identifies stones as hyperechoic structures with posterior shadowing and recognizes secondary signs of obstruction. Computed tomography generally visualizes urinary calculi, even <3 mm, as high attenuating formations inside urinary tract, it identifies hydronephrosis and perinephric edema, and it is highly sensible in recognizing alternative diagnosis. The low availability of MR in emergency setting does not allow its routine use in renal colic workup but is a useful tool in the evaluation of pregnant and pediatric patients after not conclusive ultrasound imaging.

Keywords

Renal colic Urinary stones Ultrasound Computed tomography Magnetic resonance 

Supplementary material

Video 15.1

Elderly patient presenting in emergency room with acute abdominal pain. Axial reconstruction of unenhanced CT show incomplete duplication with multiple renal stones and dilation. A lumbar ureteral stone is located in the upper system, cranial to ureteral fusion, and multiple stones are impacted in the single pelvic ureter, with the typical “soft tissue rim sign”. Multiple phleboliths are also present. (AVI 23814 kb)

Video 15.2

Male patient with right renal colic. Unenhanced CT, axial images, shows moderate right hydronephrosis with fat stranding and perinephric edema. A right obstructing high attenuating stone with “soft tissue rim sign” is recognizable at pyelo-ureteral junction. (AVI 21510 kb)

Video 15.3

Male patient with right renal colic. Coronal reconstructed images of unenhanced CT show moderate right hydronephrosis with fat stranding and perinephric edema. A right obstructing high attenuating stone with a larger diameter in the longitudinal axis is recognizable at pyelo-ureteral junction. (AVI 2700 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Paola Martingano
    • 1
    Email author
  • Marco F. M. Cavallaro
    • 2
  • Fulvio Stacul
    • 2
  • Maria Assunta Cova
    • 1
  1. 1.Unità Clinico Operativa di Radiologia, Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della SaluteOspedale di Cattinara, Azienda Sanitaria Universitaria Integrata di Trieste, Università degli Studi di TriesteTriesteItaly
  2. 2.Struttura Complessa di Radiologia, Ospedale MaggioreAzienda Sanitaria Universitaria Integrata TriesteTriesteItaly

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