Unenhanced CT KUB for Urinary Colic: It's not just about the stones
Ummara Siddique, Shahjehan Alam, Aman Nawaz Khan, M Asif, Sana Iqba, Muhammad Abdullah, Aruba Nawaz, Nida Gul
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ABSTRACT
Aim: To demonstrate the use of non-contrast CT KUB in the
detection of abdominal pathologies other than stones, whether or not simulating
the clinical picture of urolithiasis, and its impact upon patient management.
Methodology: This was a cross sectional observational
study carried out in Radiology department of Rehman Medical Institute Peshawar
from Dec 2012 to May 2018. 2776 patients coming for CT KUB were included. Age
range was 10 to 90 years and patients presented with persistent or recurrent
pain in flanks. Data was collected from the hospital. CT KUB was performed for
all patients on 128 slice Toshiba Multidetector computed tomography machine.
Intravenous contrast was not given. The CT procedure used exposure factors set
at 120 kVp. The radiology reports were reviewed retrospectively, and findings
outside the urinary tract (kidneys, ureters, bladder, and urethra) were
recorded and categorized by organ system. The encountered abdominal and pelvic
pathologies other than stones were divided into two groups: incidental findings
and acute pathologies.
Results: In 2776 patients who had CT
KUB for suspected urolithiasis, 236 (8.5%) had alternative diagnoses non-
GU findings, besides urolithiasis and obstruction, there
were 63% males and 37% females. Majority patients were in the
age group 21-40 years followed by age group of 41-60 years. The encountered
acute abdominal non-renal pathologies were pancreatitis in 15, appendix related
pathologies in 46, cholelithiasis in 108, cholecystitis in 1, epiploic appendagitis
in 8 and hernia in 58 patients. Other non-KUB findings included psoas abscess
(2), bowel perforation (2), Liver masses (1), Bone metastasis(2), Dermoid
ovarian cysts (2, one of which had torsion), cervical stenosis with fluid
distended uterine cavity (1), Prostate mass (2), uterine fibroids, adrenal
adenomas(2) and many with degenerative bone changes, few with osteoporotic
collapse. Significant findings were also observed as incidentally noted
findings in visualized lower chest sections like pleural effusions, pulmonary
nodules and a malignant looking basal lung mass in one case.
Conclusion: 8.5% patients were diagnosed with
non-renal acute pathologies on non-contrast CT scan, which required immediate
intervention. Non-contrast CT scan of the urinary tract (stone protocol) is a
valuable tool in the detection of incidental findings which may simulate, or
coincide with urolithiasis and it has a significant impact upon the management
of the patients.
Key words: non-contrast CT KUB,
urolithiasis, non-renal pathologies