Thom Christopher, Eisenstat Matthew, Moak James
Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia.
J Emerg Med. 2018 Jul;55(1):96-100. doi: 10.1016/j.jemermed.2018.02.033.
Renal colic is a frequently encountered diagnosis among emergency department patients. Point-of-care (POC) ultrasound has taken on an increasingly important role in the diagnostic strategy of this disease, as it has been shown to be an effective modality for diagnosis and for guiding management. The primary pathology that the emergency physician will evaluate for in cases of suspected renal colic is hydronephrosis, which is a dilatation of the renal pelvis and calyces resulting from a distal obstruction such as a ureteral stone. However, other significant findings can be seen, one of which is the extravasation of urine around the kidney secondary to a forniceal, or calyceal, rupture.
We present three cases of unanticipated perinephric fluid collections identified initially on POC ultrasound in cases of suspected simple renal colic. Concomitant hydronephrosis was also seen in each of these cases. Why Should an Emergency Physician Be Aware of This? While the utilization of POC ultrasound in cases of suspected renal colic increases, we should be prepared to encounter and identify perinephric fluid collections in our evaluations. Although the ideal management of these cases is not completely defined from the current literature, we benefit from knowing how to identify these on POC ultrasound, understanding the underlying pathophysiology, and appreciating the possibility of complications that may arise.
肾绞痛是急诊科患者中常见的诊断。即时超声检查（POC）在这种疾病的诊断策略中发挥着越来越重要的作用，因为它已被证明是一种有效的诊断和指导治疗的方式。急诊科医生在疑似肾绞痛病例中要评估的主要病理情况是肾积水，这是由远端梗阻（如输尿管结石）导致的肾盂和肾盏扩张。然而，还可以看到其他重要发现，其中之一是因肾盏破裂导致尿液在肾脏周围外渗。
我们报告三例在疑似单纯肾绞痛病例中最初通过即时超声检查发现意外肾周液体积聚的病例。这些病例中均伴有肾积水。为什么急诊医生应该了解这一点？随着即时超声检查在疑似肾绞痛病例中的应用增加，我们在评估时应准备好遇到并识别肾周液体积聚。尽管目前文献尚未完全明确这些病例的理想治疗方法，但我们从知道如何在即时超声检查中识别这些情况、理解潜在病理生理学以及认识到可能出现的并发症中获益。
