scholarly journals Modified Whitaker test: a novel diagnostic for nephroptosis

2020 ◽  
Vol 13 (4) ◽  
pp. e235108
Author(s):  
Ralph Grauer ◽  
Mikel Gray ◽  
Noah Schenkman
Keyword(s):  
Emergency Department ◽  
Ct Scan ◽  
Renal Colic ◽  
Flank Pain ◽  
Voiding Cystourethrogram ◽  
Diuretic Renography ◽  
Initial Work ◽  
Whitaker Test ◽  
Contrast Ct ◽  
Work Up

A 77-year-old woman presented with right flank pain radiating to the ipsilateral groin and associated nausea, consistent with renal colic. In the emergency department, a non-contrast CT scan revealed severe right-sided hydronephrosis but failed to demonstrate a calculus or ureteropelvic obstruction. The patient improved with fluids and followed up with a community urologist. Initial work-up with cystoscopy and ureteroscopy, voiding cystourethrogram and diuretic renography failed to deduce a diagnosis. At our hospital, we used a modified dynamic (supine and upright) Whitaker test in a novel fashion to diagnose nephroptosis, a rare hypermobility condition of the kidney.

scholarly journals Contrast versus non-contrast CT in urinary tract calculi

2018 ◽  
Vol 5 (3) ◽  
pp. 818
Author(s):  
Sofyan Faidah ◽  
Alyaa Banjar ◽  
Jaber Zarbah ◽  
Sarah Alfaer ◽  
Mohammed Alshulayyil ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Ct Scan ◽  
Imaging Modality ◽  
Urinary Calculi ◽  
Flank Pain ◽  
Ct Scans ◽  
Advantages And Disadvantages ◽  
Urinary Tract Calculi ◽  
Diagnostic Modalities ◽  
Contrast Ct

The incidence and prevalence of urinary tract calculi has increased significantly during the past decade. Accurate fast diagnostic modalities were developed to cope with such an increased trend. To date, non-contrast CT scan remains the diagnostic modality of choice for evaluation of patients with urinary tract calculi. However, contrast CT scans are gaining more interest. In this review, both diagnostic modalities were reviewed with the advantages and disadvantages of each. Non-contrast CT scan is a rapid, accurate, less hazardous, less expensive imaging modality that has a high sensitivity in detection of urinary calculi as small as 3 mm. However, it cannot evaluate other probable causes of flank pain. Thus, contrast CT scans can be used in situations where clinical presentation is suspicious and the possibility of other differential diagnoses is considered. Contrast CT scans do not decrease the sensitivity of detecting urinary calculi, and they do have a higher sensitivity in detecting small grades of obstruction as well as evaluating other possible causes of flank pain such as neoplasms, infectious, or inflammatory aetiologies. 

scholarly journals Does mild symptomatic bradycardia in a young active female need pacemaker?

2013 ◽  
Vol 1 (1) ◽  
pp. 7-10
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Junior Doctor ◽  
Treated Patient ◽  
Holter Monitoring ◽  
Initial Work ◽  
Symptomatic Bradycardia ◽  
Work Up

46 years old women presented suddenly as fainting attack during her work shortly admitted to the emergency department and the initial work-up, a baseline electrocardiogram revealed irregular rhythm at 41 beats per minute (bpm). The patient denied ever having symptoms of presyncope, syncope, or generalized weakness. A Junior doctor in the emergency department treated patient with Amiodaron infusion to a overcome atrial fibrillation. The patient was monitored on telemetry during his 3-day admission and received Amiodaron orally 200mg×3, in addition, had a 48-hour Holter monitoring performed. He was found to have episodes of atrial fibrillation.

scholarly journals Lung ultrasound in the emergency department - a valuable tool in the management of patients presenting with respiratory symptoms during the SARS-CoV-2 pandemic

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bonaventura Schmid ◽  
Doreen Feuerstein ◽  
Corinna N. Lang ◽  
Katrin Fink ◽  
Rebecca Steger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ct Scan ◽  
Lung Ultrasound ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Information ◽  
Clinical Work ◽  
Chest Ct ◽  
Work Up ◽  
Chest Ct Scan

Abstract Background Typical lung ultrasound (LUS) findings in patients with a COVID-19 infection were reported early on. During the global SARS-CoV-2 pandemic, LUS was propagated as a useful instrument in triage and monitoring. We evaluated LUS as a rapid diagnostic triage tool for the management of patients with suspected COVID-19 in the emergency department (ED). Methods The study retrospectively enrolled patients with suspected COVID-19, who were admitted from 1st April to 25th of April 2020 to the ED of a tertiary care center in Germany. During clinical work-up, patients underwent LUS and polymerase chain reaction (PCR) testing for SARS-CoV-2. The recorded ultrasound findings were analyzed and judged regarding typical signs of viral pneumonia, blinded for clinical information of the patients. The results were compared with PCR test and chest computed tomography (CT). Results 2236 patients were treated in the ED during the study period. 203 were tested for SARS-CoV-2 using PCR, 135 (66.5%) underwent LUS and 39 (28.9%) of the patients were examined by chest CT scan. 39 (28.9%) of the 135 patients were tested positive for SARS-CoV-2 with PCR. In 52 (38.5%) COVID-19 was suspected from the finding of the LUS, resulting in a sensitivity of 76.9% and a specificity of 77.1% compared with PCR results. The negative predictive value reached 89.2%. The findings of the LUS had - compared to a positive chest CT scan for COVID-19 - a sensitivity of 70.6% and a specificity of 72.7%. Conclusions LUS is a rapid and useful triage tool in the work-up of patients with suspected COVID-19 infection during a pandemic scenario. Still, the results of the LUS depend on the physician’s experience and skills.

scholarly journals Renal Colic: A Red Herring for Mucocele of the Appendiceal Stump

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Sameera Ganti ◽  
Pothiawala Sohil
Keyword(s):  
Emergency Department ◽  
Cystic Lesion ◽  
Renal Colic ◽  
Surgical Care ◽  
Flank Pain ◽  
Ct Urography ◽  
Ureteric Calculus ◽  
Common Presentation ◽  
Appendiceal Stump ◽  
Bedside Ultrasonography

Flank pain with hematuria is a common presentation in the emergency department. The commonest differential diagnosis of these patients is renal/ureteric calculus or pyelonephritis. These patients are usually treated with analgesia, antibiotics in case of pyelonephritis, and are discharged with an outpatient referral to a urologist. This case report describes a 51 year old male who presented to the ED for recurrent flank pain and hematuria. Bedside ultrasonography in the ED demonstrated a cystic lesion in the renal area. CT urography revealed an appendiceal stump mucocele and patient was transferred under surgical care. This case highlights the importance of the utility of bedside ultrasound in patients presenting to the ED with flank pain or abdominal pain which can lead to expedited assessment and appropriate management.

Symptomatic kidney stones in an anuric patient on dialysis: A case report

2021 ◽  
pp. 039156032110359
Author(s):  
Hossein Dialameh ◽  
Farshad Namdari ◽  
Mehrdad Mahalleh ◽  
Mohammad Lotfi ◽  
Zoha Ali
Keyword(s):  
Renal Colic ◽  
Chest Ct ◽  
Chief Complaint ◽  
Flank Pain ◽  
The Past ◽  
Extracorporeal Shock Wave ◽  
Stage Renal Disease ◽  
End Stage ◽  
Prompt Diagnosis ◽  
Chest Ct Scan

Introduction: Renal colic is a colicky-type of flank pain that can commonly be presented in patients undergoing dialysis especially if they are anuric considering the fact that there are multiple controversies and little published experience on this topic, we found it very important to report this case. We also aimed to increase awareness and emphasize the importance of renal colic in anuric patients on dialysis. Case description: We herein report a case of a 42-year old man with a chief complaint of bilateral colic flank pain, He had developed end stage renal disease due to ADPKD and was on hemodialysis since the past 5 years. Previously, he went through a series of workup but was left undiagnosed. Abdomen-pelvic and chest CT scan without contrast was performed showing bilateral renal pelvic stones and some nephrocalcinosis in both kidneys. bilateral ureteroscopy was performed and bilateral DJ was installed for a total of 6 weeks and extracorporeal shock wave lithotripsy was done. With prompt diagnosis, the patient was pain free and stone free before discharge. The patient is also reported to be stone free 6 months after the procedure. Conclusion: Patients on dialysis are still capable of forming symptomatic renal tract stones even if they are anuric.

scholarly journals COVID-19 as the cause of thrombosis: recognising COVID-19 infection in apparently asymptomatic patients

2021 ◽  
Vol 14 (1) ◽  
pp. e241027
Author(s):  
Kyle B Varner ◽  
Emily J Cox
Keyword(s):  
Emergency Department ◽  
Direct Result ◽  
Abdominal Ct ◽  
Call To Action ◽  
Asymptomatic Patients ◽  
Pulmonary Manifestations ◽  
Abdominal Ct Scan ◽  
Thrombotic Complications ◽  
Work Up ◽  
Renal Thrombosis

COVID-19 has serious thrombotic complications in critically ill patients; however, thrombus is not a typical presenting symptom. This case report describes a patient with no respiratory symptoms who presented to the emergency department with abdominal pain. The pain was attributed to renal thrombosis, but the patient was found to have no risk factors for thrombotic disease and subsequent hypercoagulable work-up was unremarkable. Pulmonary manifestations of COVID-19 infection were detected incidentally on the abdominal CT scan and confirmed via PCR test. The patient was isolated and went on to develop mild respiratory failure secondary to COVID-19 infection. This case suggests that unexplained thrombus in otherwise asymptomatic patients can be a direct result of COVID-19 infection, and serves as a call to action for emergency department clinicians to treat unexplained thrombotic events as evidence of COVID-19.

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