Urological Emergencies

  • Patrice Taourel
  • Rodolphe Thuret
Part of the Medical Radiology book series (MEDRAD)


Renal colic pain due to an obstructing stone is the main renal cause of acute flank pain; however, other causes may be responsible for the same clinical findings, including acute pyelonephritis, acute vascular conditions, and hemorrhage. The purpose of this review is to describe the differential diagnosis, the CT findings and pitfalls, and the role and impact of CT in the diagnosis and management of the renal causes of acute flank pain.


Ureteral Stone Acute Pyelonephritis Intravenous Contrast Material Ureteral Calculus Renal Vein Thrombosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ahmad NA, Ather MH, Rees J (2003) Incidental diagnosis of diseases on un-enhanced helical computed tomography performed for ureteric colic. BMC Urol 3:2PubMedCrossRefGoogle Scholar
  2. Ahmed J, Mallick IH, Ahmad SM (2009) Rupture of urinary bladder: a case report and review of literature. Cases J 2:7004PubMedCrossRefGoogle Scholar
  3. Bolderman R, Oyen R, Verrijcken A et al (2006) Idiopathic renal infarction. Am J Med 119:356.e9–12PubMedCrossRefGoogle Scholar
  4. Boridy IC, Kawashima A, Goldman SM, Sandler CM (1999) Acute ureterolithiasis: nonenhanced helical CT findings of perinephric edema for prediction of degree of ureteral obstruction. Radiology 213:663–667PubMedGoogle Scholar
  5. Browne RFJ, Zwirewich C, Torreggiani WC (2004) Imaging of urinary tract infection in the adult. Eur Radiol 14:168–183CrossRefGoogle Scholar
  6. Catalano O, Nunziata A, Altei F et al (2002) Prima, helical CT versus selective helical CT after unenhanced radiography and sonography. AJR Am J Roentgenol 178:379–387PubMedGoogle Scholar
  7. Craig WD, Wagner BJ, Travis MD (2008) Pyelonephritis: radiologic-pathologic review. Radiographics 28:255–276PubMedCrossRefGoogle Scholar
  8. D’Ambrosio N, Friedman B, Siegel D et al (2007) Spontaneous isolated dissection of the celiac artery: CT findings in adults. AJR Am J Roentgenol 188:W506–W511PubMedCrossRefGoogle Scholar
  9. DeFoor W, Tackett L, Minevich E, Wacksman J, Sheldon C (2003) Risk factors for spontaneous bladder perforation after augmentation cystoplasty. Urology 62:737–741PubMedCrossRefGoogle Scholar
  10. Ege G, Akman H, Kuzucu K, Yildiz S (2003) Acute ureterolithiasis: incidence of secondary signs on unenhanced helical CT and influence on patient management. Clin Radiol 58:990–994PubMedCrossRefGoogle Scholar
  11. Fultz PJ, Hampton WR, Totterman SM (1993) Computed tomography of pyonephrosis. Abdom Imaging 18:82–87PubMedCrossRefGoogle Scholar
  12. Gentle DL, Stoller ML, Jarrett TW et al (1997) Protease inhibitor-induced urolithiasis. Urology 50:508–511PubMedCrossRefGoogle Scholar
  13. Grayson DE, Abbott RM, Levy AD, Sherman PM (2002) Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics 22:543–561PubMedGoogle Scholar
  14. Hazanov N, Somin M, Attali M et al (2004) Acute renal embolisms. Forty-four cases of renal infarction in patients with atrial fibrillation. Medicine 83:292–299PubMedCrossRefGoogle Scholar
  15. Joffe SA, Servaes S, Okon S, Horowitz M (2003) Multi-detector row CT urography in the evaluation of hematuria. Radiographics 23:1441–1456PubMedCrossRefGoogle Scholar
  16. Kamel IR, Berkowitz JF (1996) Assessment of the cortical rim sign in posttraumatic renal infarction. J Comput Assist Tomogr 20:803–806PubMedCrossRefGoogle Scholar
  17. Kanofskh JA, Lepor H (2007) Spontaneous renal artery dissection. Urology 9:156–160Google Scholar
  18. Katz DS, Scheer M, Lumerman JH et al (2000) Alternative or additional diagnoses on unenhanced helical computed tomography for suspected renal colic: experience with 1000 consecutive examinations. Urology 56:53–57PubMedCrossRefGoogle Scholar
  19. Kawashima A, Sandler CM, Ernst RD et al (1999) Imaging of nontraumatic hemorrhage of the adrenal gland. Radiographics 19:949–963PubMedGoogle Scholar
  20. Kawashima A, Sandler CM, Emst RD et al (2000) CT evaluation of renovascular disease. Radiographics 20:1321–1340PubMedGoogle Scholar
  21. Levenson RB, Singh AK, Novelline RA (2008) Fournier gangrene: role of imaging. Radiographics 28:519–528PubMedCrossRefGoogle Scholar
  22. Levine E, Grantham JJ (1985) High-density renal cysts in autosomal dominant polycystic kidney disease demonstrated by CT. Radiology 154:477–482PubMedGoogle Scholar
  23. Levine J, Neitlich J, Smith RC (1999) The value of prone scanning to distinguish ureterovesical junction stones from ureteral stones that have passed into the bladder: leave no stone unturned. AJR Am J Roentgenol 172:977–981PubMedGoogle Scholar
  24. Liach F, Paper S, Massry SG (1980) The clinical spectrum of renal vein thrombosis: acute and chronic. Am J Med 69:819–827CrossRefGoogle Scholar
  25. Liu CC, Li CC, Shih MC et al (2003) Matrix stone. J Comput Assist Tomogr 27:810–813PubMedCrossRefGoogle Scholar
  26. Luchs JS, Katz DS, Lane MJ et al (2002) Utility of hematuria testing in patients with suspected renal colic: correlation with unenhanced helical CT results. Urology 59:839–842PubMedCrossRefGoogle Scholar
  27. Memarsadeghi M, Heinz-Peer G, Helbich TH et al (2005) Unenhanced multidetector row CT in patients suspected of having urinary stone disease: effect of section width on diagnosis. Radiology 235:530–536PubMedCrossRefGoogle Scholar
  28. Memarsadeghi M, Schaefer-Prokop C, Prokop M et al (2007) Unenhanced MDCT in patients with suspected urinary stone disease: do coronal reformations improve diagnostic performance? AJR Am J Roentgenol 189:60–64CrossRefGoogle Scholar
  29. Muraoka N, Sakai T, Kimura H et al (2008) Rare causes of hematuria associated with various vascular diseases involving the upper urinary tract. Radiographics 28:855–867PubMedCrossRefGoogle Scholar
  30. Narlawar RS, Raut AA, Nager A et al (2004) Imaging features and guided drainage in emphysematous pyelonephritis: a study of 11 cases. Clin Radiol 59:192–197PubMedCrossRefGoogle Scholar
  31. Poletti PA, Platon A, Rutschmann OT et al (2006) Abdominal plain film in patients admitted with clinical suspicion of renal colic: should it be replaced by low-dose computed tomography? Urology 67:64–68PubMedCrossRefGoogle Scholar
  32. Poletti PA, Platon A, Rutschmann OT et al (2007) Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol 188:927–933PubMedCrossRefGoogle Scholar
  33. Prando A, Prando D, Prando P (2006) Renal cell carcinoma: unusual imaging manifestations. Radiographics 26:233–244PubMedCrossRefGoogle Scholar
  34. Press SM, Smith AD (1995) Incidence of negative hematuria in patients with acute urinary lithiasis presenting to the emergency room with flank pain. Urology 45:753–757PubMedCrossRefGoogle Scholar
  35. Ramamoorthy SL, Vasquez JC, Taft PM et al (2002) Nonoperative management of acute spontaneous renal artery dissection. Ann Vasc Surg 16:157–162PubMedCrossRefGoogle Scholar
  36. Rucker CM, Menias CO, Bhalla S (2004) Mimics of renal colic: alternative diagnoses at unenhanced helical CT. Radiographics 24:S11–S33PubMedCrossRefGoogle Scholar
  37. Segura JW, Preminger GM, Assimos DG et al (1997) Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. J Urol 158:1915–1921PubMedCrossRefGoogle Scholar
  38. Stunell H, Buckley O, Feeney J et al (2007) Imaging of acute pyelonephritis in the adult. Eur Radiol 17:1820–1828PubMedCrossRefGoogle Scholar
  39. Talner LB, Davidson AJ, Lebowitz RL et al (1994) Acute pyelonephritis: can we agree on terminology? Radiology 192:297–305PubMedGoogle Scholar
  40. Talner L, Vaughan M (2003) Nonobstructive renal causes of flank pain: findings on noncontrast helical CT (CT KUB). Abdom Imaging 28:210–216PubMedCrossRefGoogle Scholar
  41. Tamm EP, Silverman PM, Shuman WP (2003) Evaluation of the patient with flank pain and possible ureteral calculus. Radiology 228:319–329PubMedCrossRefGoogle Scholar
  42. Teichman JMH (2004) Acute renal colic from ureteral calculus. N Engl J Med 350:684–693PubMedCrossRefGoogle Scholar
  43. Thomas AA, Lane BR, Thomas A et al (2007) Emphysematous cystitis: a review of 135 cases. Journal Compilation 100:17–20Google Scholar
  44. Vieweg J, The C, Freed K et al (1998) Unenhanced helical computerized tomography for the evaluation of patients with acute flank pain. J Urol 160:679–684PubMedCrossRefGoogle Scholar
  45. Wan YL, Lee TY, Bullard MJ et al (1996) Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology 198:433–438PubMedGoogle Scholar
  46. Wong-You Cheong J, Woodward PJ, Manning MA, Davis CJ (2006) From the archives of the AFIP: inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radiographics 26:1847–1868PubMedCrossRefGoogle Scholar
  47. Yanar H, Taviloglu K, Ertekin C et al (2006) Fournier’s gangrene: risk factors and strategies for management. World J Surg 30:1750–1754PubMedCrossRefGoogle Scholar
  48. Zhang JQ, Fielding JR, Zou KH (2002) Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol 167:1593–1596PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of ImagingHôpital LapeyronieMontpellier Cedex 5France
  2. 2.Department of UrologyHôpital LapeyronieMontpellier Cedex 5France

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