Taşın Ötesinde: Acil Serviste Renal Kolik İçin Kontrastsız Bilgisayarlı Tomografinin Tanısal Değeri

Öz

Amaç: Renal kolik, çoğunlukla idrar yolu taşlarından kaynaklanan acil servis (AS) ziyaretlerinin önemli bir nedenidir. Abdominal bilgisayarlı tomografi (BT), renal kolik şüphesi olan hastaların değerlendirilmesinde önemli bir rol oynar ve taşların varlığı, boyutu ve yeri ile idrar yolu tıkanıklığı derecesi hakkında ayrıntılı bilgi sağlar. Bu çalışma, AS'de renal kolik şüphesi olan hastalar için istenen abdominal BT taramalarının tanısal etkinliğini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif çalışmada, 1 Ocak 2022 ile 31 Aralık 2022 tarihleri arasında üçüncü basamak bir acil servisteki vakalar incelendi. Renal kolik tanısı konulan hastalar için hasta kayıtları incelendi, demografik veriler, laboratuvar ve görüntüleme sonuçları, abdominal BT'den elde edilen ürolojik tanı bulguları, ek tanı bulguları, konsültasyonlar, acil servis sonuçları, nihai tanılar ve BT bulgularının acil servis yönetimi üzerindeki etkisine ait veriler toplandı. Bulgular: Dahil edilen hastaların %66,8'i erkekti ve medyan yaşları 42 idi. Olguların %27,3'üne transabdominal ultrasonografi yapılırken, tüm hastalara abdominal BT çekildi. Hastaların %65,5'inde ürolojik bulgular tespit edildi, %60,1'inde idrar yolu taşı ve %53,7'sinde hidronefroz veya pelvikaliektazi mevcuttu. Abdominal BT bulguları, olguların %10,2'sinde ürolojik tedaviyi etkiledi ve %2,2'sinde diğer uzmanlık alanları tarafından uygulanan tedaviyi etkiledi. Hastaların çoğunluğu (%94,9) acil servisten taburcu edildi. Sonuç: Kontrastsız abdominal BT, taşların varlığını doğrulayarak ve alternatif tanıları belirleyerek acil serviste klinik yönetimi yönlendirebilen güçlü bir tanı aracıdır.

Anahtar Kelimeler

• Abdominal bilgisayarlı tomografi
• acil servis
• yan ağrısı
• renal kolik

Beyond the Stone: Diagnostic Value of Non-Contrast Computed Tomography for Renal Colic in the Emergency Department

Öz

Aim: Renal colic is a common cause of emergency department (ED) visits, most frequently resulting from urinary tract calculi. Abdominal computed tomography (CT) plays a pivotal role in evaluating patients with suspected renal colic by providing detailed information on the presence, size, and location of stones, as well as the degree of urinary obstruction. This study aimed to assess the diagnostic accuracy and clinical impact of abdominal CT scans ordered in the ED for patients presenting with suspected renal colic. Material and Methods: This retrospective study was conducted in a tertiary care urban ED and included patients diagnosed with renal colic between January 1, 2022, and December 31, 2022. Demographic characteristics, laboratory and imaging findings, CT-based urological findings, additional diagnoses, consultation requirements, ED outcomes, final diagnoses, and the impact of CT results on clinical management were analyzed. Results: Among the included patients, 66.8% were male, with a median age of 42 years. Transabdominal ultrasound was performed in 27.3% of cases, while all patients underwent abdominal CT. Urological findings were observed in 65.5% of cases, including urinary tract calculi (60.1%) and hydronephrosis or pelvicaliectasis (53.7%). CT findings altered urological management in 10.2% of cases and influenced the management approach of other specialties in 2.2%. Most patients (94.9%) were discharged from the ED. Conclusion: Non-contrast abdominal CT is a highly effective diagnostic modality in patients presenting with suspected renal colic, providing accurate detection of urinary stones and contributing to clinical decision-making by identifying both urological and non-urological pathologies.

Anahtar Kelimeler

• Abdominal computed tomography
• emergency department
• flank pain
• renal colic

Kaynakça

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