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Unenhanced CT for the evaluation of acute ureteric colic: the essential pictorial guide
  1. Steven J Kennish1,
  2. Tze M Wah2,
  3. Henry C Irving2
  1. 1Leeds Teaching Hospitals, Leeds Radiology Academy, Leeds, UK
  2. 2Department of Clinical Radiology, St James University Hospital, Leeds, UK
  1. Correspondence to Dr Steven J Kennish, Leeds Teaching Hospitals, Leeds Radiology Academy, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK; s_kennish{at}


Acute ureteric colic is a common emergency, often dealt with by the emergency physician or general practitioner and referred on to the urologist. Unenhanced CT of the kidneys, ureters and bladder (CTKUB) is the ‘gold standard’ imaging investigation for establishing a diagnosis and guiding management. An appreciation of the CTKUB signs, which support or refute a diagnosis of ureteric colic, is highly valuable to the clinician when making a urological referral, and to the urologist, who must make appropriate management plans. All salient diagnostic and supportive features of ureteric colic are carefully illustrated, as are important radiological mimics, with the objectives of educating and informing the non-radiologist. Ready access to the picture archive and communication system (PACS) allows all specialists involved to interpret the radiological report with the benefit of images. A stone within the ureter may not always be readily apparent. Soft tissue rim sign around a calcific focus is an important indicator of a ureteric stone, whereas a comet tail sign suggests a phlebolith (a calcified venous thrombosis), a radiological mimic of a ureteric stone. Numerous secondary signs of ureteric obstruction may be present including hydronephrosis and perinephric stranding, and can help to confirm the diagnosis. The relative diagnostic weighting of signs is discussed, and a checklist is provided to assist with interpretation. Unexpected alternative radiological diagnoses are also illustrated, which may have significant management consequences necessitating specialist referral.

  • Ureteric colic
  • genitourinary imaging

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  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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