Alternative Diagnoses on CT Urography in Patients with Acute Flank Pain: Prevalence 620 Consecutive Examinations

Flank pain is a typical cause of visit to the Emergency Department and frequently requires imaging evaluation. There are numerous diseases that may manifest as acute flank pain because genitourinary tract and gastrointestinal tract share the same autonomic innervation. This leads to poor localization of visceral pain and nonspecific clinical findings. Computed Tomography Urography (CTU) revolutionized the imaging evaluation of flank pain. CTU may reveal wide variety of unsuspected findings in many of which can help explain the patient's condition. This study had two main objectives. Firstly, to obtain the prevalence of clinically significant alternative diagnoses on CTU in patients with acute flank pain in KPJ Damansara Specialist Hospital. Secondly, to assess the distribution of the alternative diagnoses on CTU in patients with acute flank pain and to categorize the findings in the order of its clinical importance. A total of 620 subjects who underwent CTU in KPJ Damansara Specialist Hospital from the period of 1st May 2018 until 31st May 2019 were included. The CTU images from the 620 subjects were retrospectively reviewed to assess the clinical significance of the incidental findings. Clinically significant alternative diagnoses are considered when the respective patients warrant further imaging studies, pathological correlation and subsequently urgent medical treatment or surgical intervention. The prevalence of clinically significant alternative diagnoses in patients with acute flank pain in this study is 7.3%.