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Investigation of loin pain

Departments of Radiology ¹ and Urology ² , Derriford Hospital, Plymouth PL6 8DH, UK

• Clinical examination and urinalysis are usually insufficient for diagnosis in patients with loin pain.
  
• Although the majority of renal stones are radioopaque, plain film radiography is not sufficiently accurate in the identification of ureteric stones to be used as the only imaging investigation.
  
• Intravenous urography is good for diagnosing ureteric obstruction but is limited in its demonstration of ureteric stones when compared with CT.
  
• Ultrasound, incorporating Doppler techniques, is able to diagnose ureteric obstruction with a high degree of accuracy but cannot directly demonstrate ureteric calculi in most cases.
  
• Ultrasound, proceeding to MRI in selected cases, is the investigations of choice in pregnant patients with loin pain.
  
• Unenhanced CT is the investigation of choice for most patients with loin pain owing to its unrivalled accuracy, speed and ability to demonstrate other renal and non-renal pathologies.
  
• Low-dose techniques should be routinely applied to CT KUB examinations.
  
• Stone size and location are the most important factors in predicting spontaneous passage of a stone.
  

Patients with acute loin pain regularly present for emergency medical care. In most, renal obstruction due to an ureteric stone will be the prime diagnostic consideration; however, there are many other renal and non-renal pathologies that may present with loin pain. Imaging investigations are indispensable in achieving a rapid and accurate diagnosis and in planning treatment. This article reviews the technique and diagnostic efficacy of the various radiological investigations that are used in patients with suspected ureteric colic, and describes an approach to their interpretation. The use of unenhanced CT will be considered in detail, as this modality is now the investigation of choice in the majority of these patients. The modern management of renal stone disease will also be reviewed briefly. Finally, other renal and non-renal causes of loin pain that may be encountered will be discussed.