eMedicine Specialties > Clinical Procedures > Radiology

Bedside Ultrasonography, Obstructive Uropathy

Author: Timothy Jang, MD, Assistant Professor of Medicine, Director of Emergency Ultrasound, David Geffen School of Medicine at UCLA, Olive View-UCLA Medical Center; Clinical Faculty, Washington University School of Medicine
Coauthor(s): Christopher Angemi, DO, Clinical Instructor, David Geffen School of Medicine, University of California at Los Angeles; Emergency Ultrasound Fellow, Department of Emergency Medicine, Harbor-UCLA Medical Center; Staff Physician, Department of Emergency Medicine, Bakersfield Memorial Hospital
Contributor Information and Disclosures

Updated: Jan 12, 2010

Introduction

Patients who present to the emergency department (ED) or other ambulatory care setting commonly report abdominal and flank pain. Unfortunately, patient history and physical examination often lack the necessary sensitivity and specificity to accurately diagnose underlying etiologies without further testing. Focused bedside ultrasonography is a valuable diagnostic tool that can often facilitate a timely diagnosis for these patients.1,2,3 4

Ultrasonography is especially important in determining the cause of the sudden onset of abdominal or flank pain, since patients with symptomatic abdominal aneurysms can be difficult to distinguish from those with renal colic. In fact, making an accurate diagnosis of ureteronephrolithiasis is especially important, since renal colic is the most common misdiagnosis in patients with missed abdominal aortic aneurysms.

The benefits of focused emergency renal sonography (FERS) include the following:

  • Decreases the time to diagnosis for obstructive uropathy
  • Helps accurately diagnose obstructive uropathy5
  • Helps assess the degree of obstruction in renal colic
  • Helps rule out other, more dangerous, pathology (eg, symptomatic aortic aneurysm)6
  • Helps identify obstructive causes of renal insufficiency
  • Is safe in pregnant patients and children and requires less radiation than either intravenous pyelography (IVP) or helical CT7,8,9,10

Indications

Indications for focused emergency renal sonography (FERS) include the following:

  • Sudden onset of abdominal pain
  • Colicky flank pain that radiates to the groin
  • Hematuria
  • Acute renal insufficiency or failure
  • Urinary retention
  • Pyelonephritis
  • Trauma
While renal masses and cysts can often be identified by FERS, these are outside the scope of emergency ultrasonography. Patients with suspected renal masses or cysts should be referred to a radiologist for further evaluation.

Contraindications

Performance of focused emergency renal sonography (FERS) should not delay the initiation of emergent treatments such as intravenous fluids or pressors, when indicated. Although ongoing resuscitation and extremis are not contraindications, FERS can be difficult to perform in such situations.

More on Bedside Ultrasonography, Obstructive Uropathy

Overview: Bedside Ultrasonography, Obstructive Uropathy
Treatment & Medication: Bedside Ultrasonography, Obstructive Uropathy
Multimedia: Bedside Ultrasonography, Obstructive Uropathy
References
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References

  1. Henderson SO, Hoffner RJ, Aragona JL, Groth DE, Esekogwu VI, Chan D. Bedside emergency department ultrasonography plus radiography of the kidneys, ureters, and bladder vs intravenous pyelography in the evaluation of suspected ureteral colic. Acad Emerg Med. Jul 1998;5(7):666-71. [Medline].

  2. Noble VE, Brown DF. Renal ultrasound. Emerg Med Clin North Am. Aug 2004;22(3):641-59. [Medline].

  3. Watkins S, Bowra J, Sharma P, Holdgate A, Giles A, Campbell L. Validation of emergency physician ultrasound in diagnosing hydronephrosis in ureteric colic. Emerg Med Australas. Jun 2007;19(3):188-95. [Medline].

  4. Kartal M, Eray O, Erdogru T, Yilmaz S. Prospective validation of a current algorithm including bedside US performed by emergency physicians for patients with acute flank pain suspected for renal colic. Emerg Med J. May 2006;23(5):341-4. [Medline].

  5. Gaspari RJ, Horst K. Emergency ultrasound and urinalysis in the evaluation of flank pain. Acad Emerg Med. Dec 2005;12(12):1180-4. [Medline].

  6. Cupisti A, Pasquali E, Lusso S, Carlino F, Orsitto E, Melandri R. Renal colic in Pisa emergency department: epidemiology, diagnostics and treatment patterns. Intern Emerg Med. Apr 24 2008;[Medline].

  7. Dalrymple NC, Verga M, Anderson KR, Bove P, Covey AM, Rosenfield AT, et al. The value of unenhanced helical computerized tomography in the management of acute flank pain. J Urol. Mar 1998;159(3):735-40. [Medline].

  8. Manthey DE, Teichman J. Nephrolithiasis. Emerg Med Clin North Am. Aug 2001;19(3):633-54, viii. [Medline].

  9. Levy JA, Noble VE. Bedside ultrasound in pediatric emergency medicine. Pediatrics. May 2008;121(5):e1404-12. [Medline].

  10. Levy JA, Bachur RG. Bedside ultrasound in the pediatric emergency department. Curr Opin Pediatr. Jun 2008;20(3):235-42. [Medline].

  11. Ma OJ, Mateer JR, Blavias M. Renal. In: Emergency ultrasound. 2nd ed. New York: McGraw Hill; 2008:235.

  12. Sinclair D, Wilson S, Toi A, Greenspan L. The evaluation of suspected renal colic: ultrasound scan versus excretory urography. Ann Emerg Med. May 1989;18(5):556-9. [Medline].

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Further Reading

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Keywords

focused emergency renal sonography, FERS, renal ultrasound, bedside ultrasound, bedside ultrasonography, renal colic, obstructive uropathy, hydronephrosis, kidney ultrasound

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Contributor Information and Disclosures

Author

Timothy Jang, MD, Assistant Professor of Medicine, Director of Emergency Ultrasound, David Geffen School of Medicine at UCLA, Olive View-UCLA Medical Center; Clinical Faculty, Washington University School of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher Angemi, DO, Clinical Instructor, David Geffen School of Medicine, University of California at Los Angeles; Emergency Ultrasound Fellow, Department of Emergency Medicine, Harbor-UCLA Medical Center; Staff Physician, Department of Emergency Medicine, Bakersfield Memorial Hospital
Christopher Angemi, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, and California Medical Association
Disclosure: Nothing to disclose.

Medical Editor

James Quan-Yu Hwang, MD, Attending Physician, Department of Emergency Medicine, Brigham & Women's Hospital; Clinical Instructor, Harvard Medical School
James Quan-Yu Hwang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Institute of Ultrasound in Medicine
Disclosure: 3rd Rock Ultrasound, LLC Salary Speaking and teaching; Schlesinger Associates Consulting fee Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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