Case of the Month: December, 2012, Page 3

Answer: D--Abdomen and pelvis with contrast. According to the 2011 ACR appropriateness criteria, acute onset flank pain with clinical suspicion of nephrolithiasis is best addressed first with a CT Abdomen and Pelvis without contrast, reduced-dose techniques preferred. If CT without contrast does not explain pain or if an abnormality is detected on CT without contrast, a CT with contrast should be performed.

Question: According to the ACR appropriateness criteria, what is the best initial diagnostic test if you suspect nephrolithiasis AND the patient is a pregnant female?

  1. Abdominal radiograph (KUB)
  2. Renal and bladder ultrasound
  3. MRI
  4. CT Abdomen and pelvis with contrast
  5. CT abdomen and pelvis without contrast
  6. CT Abdomen with contrast
  7. CT Abdomen without contrast
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