Kidney stone differential diagnosis: Difference between revisions

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! rowspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal Pathology
! rowspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal Pathology
|'''Nephrolithiasis'''
! align="center" style="background:#DCDCDC;" + |Nephrolithiasis
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* Inadequate dietary [[calcium]] intake
* Inadequate dietary [[calcium]] intake
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* Radiolucent stone
* Radiolucent stone
|-
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|'''[[Pyelonephritis]]'''
! align="center" style="background:#DCDCDC;" + |[[Pyelonephritis]]
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* [[Urinary tract obstruction]]
* [[Urinary tract obstruction]]
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* Foci from [[abscess]] pockets
* Foci from [[abscess]] pockets
|-
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|'''[[Renal infarct]]'''
! align="center" style="background:#DCDCDC;" + |[[Renal infarct]]
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* [[Sickle-cell disease|Sickle cell disease]] or trait
* [[Sickle-cell disease|Sickle cell disease]] or trait
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* Decreased contrast uptake
* Decreased contrast uptake
|-
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|'''[[Renal papillary necrosis]]'''
! align="center" style="background:#DCDCDC;" + |[[Renal papillary necrosis]]
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* [[Analgesic]] use
* [[Analgesic]] use
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* Hyperattenuated [[medullary]] [[Calcification|calcifications]]
* Hyperattenuated [[medullary]] [[Calcification|calcifications]]
|-
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|'''[[Renal cell carcinoma]]'''
! align="center" style="background:#DCDCDC;" + |[[Renal cell carcinoma]]
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* History of [[smoking]]
* History of [[smoking]]
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* Homogenous to irregular contrast enhancement
* Homogenous to irregular contrast enhancement
|-
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|'''Urethral stricture'''
! align="center" style="background:#DCDCDC;" + |[[Urethral stricture]]
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* Prior [[urinary tract]] surgery
* Prior [[urinary tract]] surgery
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! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Gynecological pathology
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Gynecological pathology
|'''[[Pelvic inflammatory disease]]'''
! align="center" style="background:#DCDCDC;" + |[[Pelvic inflammatory disease]]
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* [[Endometritis]]
* [[Endometritis]]
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* Thick-walled, complex fluid collection with septa formation ([[abscess]] pockets)
* Thick-walled, complex fluid collection with septa formation ([[abscess]] pockets)
|-
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|'''[[Ovarian torsion]]'''
! align="center" style="background:#DCDCDC;" + |[[Ovarian torsion]]
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* Sudden acute [[pain]]
* Sudden acute [[pain]]
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* Possible underlying [[ovarian]] lesion
* Possible underlying [[ovarian]] lesion
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|'''[[Ectopic pregnancy]]'''
! align="center" style="background:#DCDCDC;" + |[[Ectopic pregnancy]]
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* History of previous [[ectopic pregnancy]]
* History of previous [[ectopic pregnancy]]
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! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Prostate pathology
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Prostate pathology
|'''[[Prostatitis]]'''
! align="center" style="background:#DCDCDC;" + |[[Prostatitis]]
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* Bacterial infection by:
* Bacterial infection by:
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|-
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|'''[[Prostatic cancer]]'''
! align="center" style="background:#DCDCDC;" + |[[Prostatic cancer]]
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* [[Family history]] of [[Prostate cancer|prostate cance]]<nowiki/>r (1st degree relatives)
* [[Family history]] of [[Prostate cancer|prostate cance]]<nowiki/>r (1st degree relatives)
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! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Testicular pathology
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Testicular pathology
|'''[[Testicular torsion]]'''
! align="center" style="background:#DCDCDC;" + |[[Testicular torsion]]
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* Age 12 - 16 years
* Age 12 - 16 years
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* [[Doppler ultrasound]] > [[Computed tomography|CT scan]] for diagnosis (abscence of [[blood]] flow in the affected [[Testicle|testis]])
* [[Doppler ultrasound]] > [[Computed tomography|CT scan]] for diagnosis (abscence of [[blood]] flow in the affected [[Testicle|testis]])
|-
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|'''[[Orchitis]]'''
! align="center" style="background:#DCDCDC;" + |[[Orchitis]]
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* Unprotected sexual intercourse
* Unprotected sexual intercourse
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|-
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! rowspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" + |Abdominal pathology
! rowspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" + |Abdominal pathology
|'''[[Cholecystitis]]'''
! align="center" style="background:#DCDCDC;" + |[[Cholecystitis]]
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* Female gender
* Female gender
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* [[Gallstones]]
* [[Gallstones]]
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|'''[[Appendicitis]]'''
! align="center" style="background:#DCDCDC;" + |[[Appendicitis]]
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* Male gender
* Male gender
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* [[Adenopathy]]
* [[Adenopathy]]
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|'''[[Diverticulitis]]'''
! align="center" style="background:#DCDCDC;" + |[[Diverticulitis]]
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* [[Diverticulosis]]
* [[Diverticulosis]]
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* Pericolic fat stranding
* Pericolic fat stranding
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|'''[[Abdominal aortic aneurysm]]'''
! align="center" style="background:#DCDCDC;" + |[[Abdominal aortic aneurysm]]
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* [[Hypertension]]
* [[Hypertension]]
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* Helical CT has faster scanning time (30 to 60 seconds) and the ability to obtain all images in one breath hold
* Helical CT has faster scanning time (30 to 60 seconds) and the ability to obtain all images in one breath hold
|-
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|'''[[Portal vein thrombosis]]'''
! align="center" style="background:#DCDCDC;" + |[[Portal vein thrombosis]]
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* Mutated JAK2 V617F
* Mutated JAK2 V617F
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** Tumor thrombus exhibits enhancement
** Tumor thrombus exhibits enhancement
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|'''[[Duodenal ulcer]]'''
! align="center" style="background:#DCDCDC;" + |[[Duodenal ulcer]]
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* Pain relieved by intake of food
* Pain relieved by intake of food
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* [[Endoscopy]] > [[CT scan]] for diagnosis
* [[Endoscopy]] > [[CT scan]] for diagnosis
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|'''[[Ischemic colitis]]'''
! align="center" style="background:#DCDCDC;" + |[[Ischemic colitis]]
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* Age > 60 years
* Age > 60 years

Revision as of 23:14, 4 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2] Amandeep Singh M.D.[3]

Overview

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuria, nausea and vomiting.

Differentiating Nephrolithiasis from other Diseases

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuria, nausea and vomiting. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]

Category Disease Risk factors Symptoms Signs Paraclinical studies
Pain N/V Anorexia Constipation Urinary symptoms Fever HR BP Tenderness Pelvic Exam Rectal Exam CBC Urinalysis BUN Cr Urine Beta-hCG LFT Serum amylase & lipase CT
Renal Pathology Nephrolithiasis + +/- - + - Nl - Nl Nl Nl Nl Nl - Nl Nl
  • Radiolucent stone
Pyelonephritis + +/- - + +
  • Positive renal punch sign
  • Costovertebral angle tenderness
Nl Nl Nl Might be + Nl Nl
  • Decreased contrast uptake
  • Foci from abscess pockets
Renal infarct + - - - + - Nl Nl Nl to ↑ Nl - Nl Nl
  • Decreased contrast uptake
Renal papillary necrosis - - - + + +/- - Nl Nl Nl Nl to ↑ Nl - Nl Nl
Renal cell carcinoma + + +/- - - - -
  • Flank mass
Nl Nl Nl - Nl Nl
Urethral stricture - - - - + - - Nl - Nl Nl - Nl to ↑ Nl - Nl Nl Nl
Gynecological pathology Pelvic inflammatory disease
  • Right/left upper quadrant
- + - + + + - Nl - Nl Nl
  • Thickening of the uterosacral ligaments
  • Haziness of the pelvic fat
  • Periovarian stranding
  • Enhancement of the adjacent peritoneum
  • Thick-walled, complex fluid collection with septa formation (abscess pockets)
Ovarian torsion
  • Sudden acute pain
  • Sharp pain aggravated by walking
  • Intermittent/colicky pain
+ - - - - + Nl - Nl - - - - - Nl Nl
  • Twisted ovarian pedicle
  • Enlarged ovary (>4.0 cm)
  • Distended pedicle
  • Possible underlying ovarian lesion
Ectopic pregnancy + + - + - + Nl
  • Positive abdominal tenderness (if ruptured)
Nl
  • Low platelet distribution width (decreased platelet activation)
  • Monocytosis
- - - + Might be abnormal Nl N/A
Prostate pathology Prostatitis - - - + + + Nl - Nl - - - Nl Nl
Prostatic cancer - - + - + - - Nl - Nl - - Nl Nl
Testicular pathology Testicular torsion + +/- - +/- - + Nl - Nl - - - - - Nl Nl
Orchitis + - - +/- + + Nl - Nl - - - - Nl Nl
Abdominal pathology Cholecystitis + + - - + + Nl - Nl Nl - - - Might be abnormal Might be abnormal
  • Gallbladder distention
  • Wall thickening
  • Mucosal hyperenhancement,
  • Pericholecystic fat stranding or fluid
  • Gallstones
Appendicitis + + - +/- + + Nl + Nl Nl
  • Leukocytosis
- - - - Nl Abnormal (if perforation)
Diverticulitis + + + - + + Nl - Nl - - - - Nl Abnormal (if perforation)
  • Colonic wall thickening (wall thickness is greater than 3 mm on the short axis of the lumen)
  • Pericolic fat stranding
Abdominal aortic aneurysm - - - - - + Nl
  • Positive abdominal tenderness (if rupture)
Nl Nl - - - - - Nl Nl
  • Ultrasound more sensitive than CT scan
  • CT scan may accurately predict the aneurysmal size
  • Helical CT has faster scanning time (30 to 60 seconds) and the ability to obtain all images in one breath hold
Portal vein thrombosis + + - - + + Nl - - - - Might be abnormal Abnormal (if bowel infarction, perforation)
  • On non-contrast CT:
    • Hyperdense thrombus
  • On contrast CT
    • Non-enhancing defect of bland thrombus
    • Tumor thrombus exhibits enhancement
Duodenal ulcer + - - - + + Nl - - Nl Abnormal (if bowel perforation)
Ischemic colitis + + + - + + ↑ or ↓ (if necrosis or sepsis)
  • Positive abdominal tenderness (if transmural necrosis)
Nl - - Nl Abnormal (if bowel perforation)

References

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