Ng Carrie, Tsung James W
Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
J Emerg Med. 2015 Aug;49(2):165-71. doi: 10.1016/j.jemermed.2015.01.017. Epub 2015 Apr 29.
Although renal colic in children in the United States remains relatively uncommon compared to in adults, its incidence has nearly doubled from 1999 to 2008. Noncontrast computed tomography (CT) is the current standard for the evaluation of suspected renal colic, given its high sensitivity and specificity. However, the greater lifetime risk of radiation-induced cancer from CT in pediatric patients has led to efforts to minimize radiation exposure. Additionally, pediatric renal colic is often recurrent, which might require multiple imaging studies during their lifetime. Point-of-care ultrasound (POCUS) by emergency physicians avoids radiation, has a low marginal cost, can be performed concurrently with other management, and allows for earlier diagnosis and more rapid treatment of renal colic. Adult randomized controlled trial evidence supports using POCUS as the initial approach to imaging and management of suspected renal colic. However, there remain limited data on POCUS in children for renal colic.
This is a case series where the sonographic findings of hydronephrosis, ureteral jets, "twinkling artifact," and the identification of urinary tract stones were used to evaluate adolescent and pediatric patients with renal colic. We report five cases of renal colic in adolescent and pediatric patients where urolithiasis was confirmed by using POCUS and irradiation by CT was avoided in all 5 patients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS can provide information about the presence or absence of urinary tract stones as well as obstruction of the collecting system without the cost and radiation exposure of CT.
尽管在美国儿童肾绞痛的发生率与成人相比仍然相对较低，但从1999年到2008年其发病率几乎翻了一番。鉴于非增强计算机断层扫描（CT）具有高敏感性和特异性，它是目前评估疑似肾绞痛的标准方法。然而，儿科患者因CT辐射诱发癌症的终身风险更高，这促使人们努力将辐射暴露降至最低。此外，儿科肾绞痛常反复发作，这可能需要在其一生中进行多次影像学检查。急诊医生进行的床旁超声检查（POCUS）可避免辐射，边际成本低，可与其他治疗同时进行，并能更早诊断和更快速治疗肾绞痛。成人随机对照试验证据支持将POCUS作为疑似肾绞痛影像学检查和治疗的初始方法。然而，关于POCUS在儿童肾绞痛方面的数据仍然有限。
这是一个病例系列，其中肾盂积水、输尿管喷射、“闪烁伪像”的超声检查结果以及尿路结石的识别被用于评估患有肾绞痛的青少年和儿科患者。我们报告了5例青少年和儿科肾绞痛病例，通过POCUS确诊为尿路结石，所有5例患者均避免了CT照射。
急诊医生为何应了解这一点？：POCUS可以提供有关尿路结石是否存在以及集合系统梗阻的信息，而无需承担CT的费用和辐射暴露风险。
