Sonography First for Acute Flank Pain?

s part of the Sound Judgment Series, this article describes the case of a patient presenting with acute flank pain and a classic clinical picture of a first episode of renal colic. The epidemiologic characteristics, pathophysiologic characteristics, risk factors, and initial assessment of patients with renal colic are briefly discussed. Imaging options are discussed, with emphasis on sonography and computed tomography (CT). Although CT is typically a first-line test in the United States and is very accurate, there is increasing awareness of the radiation risk associated with CT scanning. Sonography may directly visualize kidney stones and/or evidence of ureteral obstruction and may obviate the need for CT scanning. Sonography is typically the first-line test in Europe, even in a first episode of kidney stones. We submit that sonography as an initial imaging modality in suspected kidney stones should be considered more often, particularly in younger and female patients with classic symptoms on first presentation and in patients with symptoms consistent with their prior episodes of renal colic, reserving CT for patients in whom symptoms do not resolve or there is a suspicion of alternative diagnoses. Decisions about imaging may offer an opportunity for shared decision making about what initial imaging modality to use. Clinical Case