Ultrasound for the Diagnosis and Management of Suspected Urolithiasis in the Emergency Department



      This review provides practicing emergency physicians updated information regarding point-of-care ultrasound (POCUS) imaging of patients with suspected urolithiasis.


      A PubMed literature search was conducted for articles published between January 1, 1996 and May 31, 2017 and limited to human clinical trials written in English with relevant keywords. High-quality studies identified then underwent a structured review. Recommendations herein are made based on the literature review.


      Two hundred seventy-two abstracts fulfilling the search criteria were screened and 10 appropriate articles were rigorously reviewed in detail. There were 8 prospective studies and 2 retrospective studies. Only 1 of them was a multi-institutional randomized trial. POCUS performed in the emergency department (ED) is moderately sensitive and specific in making the diagnosis of urolithiasis in symptomatic patients. Suspected urolithiasis patients evaluated initially with ED POCUS have complication rates compatible with those evaluated initially with computed tomography.


      POCUS has moderate accuracy in making the diagnosis of urolithiasis. Nevertheless, it may be safely used as a first line of imaging in ED patients with suspected symptomatic urolithiaisis.


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        • Hyams E.S.
        • Korley F.K.
        • Pham J.C.
        • Matlaga B.R.
        Trends in imaging use during the emergency department evaluation of flank pain.
        J Urol. 2011; 186: 2270-2274
      1. Foster G, Stocks C, Borofsky MS. Emergency department visits and hospital admissions for kidney stone disease, 2009: HCUP Statistical Brief #139. Agency for Healthcare Research and Quality Rockville, MD. Available at Accessed June 10, 2017.

        • Brown J.
        Diagnostic and treatment patterns for renal colic in US emergency departments.
        Int Urol Nephrol. 2006; 38: 87-92
        • Westphalen A.C.
        • Hsia R.Y.
        • Maselli J.H.
        • Wang R.
        • Gonzales R.
        Radiological imaging of patients with suspected urinary tract stones: national trends, diagnoses, and predictors.
        Acad Emerg Med. 2011; 18: 699-707
        • Fwu C.W.
        • Eggers P.W.
        • Kimmel P.L.
        • Kusek J.W.
        • Kirkali Z.
        Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States.
        Kidney Int. 2013; 83: 479-486
        • Coursey C.A.
        • Casalino D.D.
        • Remer E.M.
        • et al.
        ACR Appropriateness Criteria(R) acute onset flank pain—suspicion of stone disease.
        Ultrasound Q. 2012; 28: 227-233
        • Brenner D.J.
        • Hall E.J.
        Computed tomography—an increasing source of radiation exposure.
        N Engl J Med. 2007; 357: 2277-2284
        • Smith-Bindman R.
        • Lipson J.
        • Marcus R.
        • et al.
        Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.
        Arch Intern Med. 2009; 169: 2078-2086
      2. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in emergency medicine. Available at: Accessed July 17, 2017.

        • Henderson S.O.
        • Hoffner R.J.
        • Aragona J.L.
        • Groth D.E.
        • Esekogwu V.I.
        • 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. 1998; 5: 666-671
        • Rosen C.L.
        • Brown D.F.
        • Sagarin M.J.
        • Chang Y.
        • McCabe C.J.
        • Wolfe R.E.
        Ultrasonography by emergency physicians in patients with suspected ureteral colic.
        J Emerg Med. 1998; 16: 865-870
        • 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. 2006; 23: 341-344
        • Moak J.H.
        • Lyons M.S.
        • Lindsell C.J.
        Bedside renal ultrasound in the evaluation of suspected ureterolithiasis.
        Am J Emerg Med. 2012; 30: 218-221
        • Gaspari R.J.
        • Horst K.
        Emergency ultrasound and urinalysis in the evaluation of flank pain.
        Acad Emerg Med. 2005; 12: 1180-1184
        • 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. 2007; 19: 188-195
        • Riddell J.
        • Case A.
        • Wopat R.
        • et al.
        Sensitivity of emergency bedside ultrasound to detect hydronephrosis in patients with computed tomography-proven stones.
        West J Emerg Med. 2014; 15: 96-100
        • Goertz J.K.
        • Lotterman S.
        Can the degree of hydronephrosis on ultrasound predict kidney stone size?.
        Am J Emerg Med. 2010; 28: 813-816
        • Fields J.M.
        • Fischer J.I.
        • Anderson K.L.
        • Mangili A.
        • Panebianco N.L.
        • Dean A.J.
        The ability of renal ultrasound and ureteral jet evaluation to predict 30-day outcomes in patients with suspected nephrolithiasis.
        Am J Emerg Med. 2015; 33: 1402-1406
        • Smith-Bindman R.
        • Aubin C.
        • Bailitz J.
        • et al.
        Ultrasonography versus computed tomography for suspected nephrolithiasis.
        N Engl J Med. 2014; 371: 1100-1110
        • Daniels B.
        • Gross C.P.
        • Molinaro A.
        • et al.
        STONE PLUS: evaluation of emergency department patients with suspected renal colic, using a clinical prediction tool combined with point-of-care limited ultrasonography.
        Ann Emerg Med. 2016; 67: 439-448