In the patient with abdominal pain and hematuria, the principal differential diagnosis is urolithiasis, although tumor and ureteropelvic junction (UPJ) obstruction should also be included. In young patients with genitourinary tract stone disease, the presenting symptoms may not be as classic as in adults, which in turn leads to uncertainty about the best imaging approach [42]. Interestingly, a number of pediatric patients with urolithiasis do not have hematuria [43]. While the incidence of pediatric stone disease is considerably lower than in adults, it is still commonly seen in busy pediatric practices [44]. Affected children may have a family history of nephrolithiasis or predisposing inborn metabolic disease [45,46]. While the literature provides general suggestions and guidelines, universal agreement regarding the imaging procedure of choice in suspected urolithiasis has not been reached. CT CT There is good evidence in adults that CT is the most accurate imaging modality in the identification of stones and the quantification of stone burden, with sensitivity and specificity both well above 90% [44,47-55]. With proper techniques and newer image iterative reconstruction algorithms, the CT dose can be very low and lowered to less than that of a traditional IVU [44,56,57]. Limitations of radiography (eg, small stone size, obscuration of stones by bowel contents) and US (eg, small stone size, obscuration of a portion of the kidney by bowel gas, poor sonographic window) in children do not impair CT evaluation. CT may be particularly useful in the setting of painful hematuria, a negative kidney and bladder US examination, and high clinical suspicion for urolithiasis, particularly if detection would impact treatment. US US of the kidneys and bladder has limited sensitivity in detection of renal and ureteral stones. Palmer et al [49] reported that US found 75% of all urinary tract stones, although US found only 38% of stones within the ureter.
Hematuria Child. In the patient with abdominal pain and hematuria, the principal differential diagnosis is urolithiasis, although tumor and ureteropelvic junction (UPJ) obstruction should also be included. In young patients with genitourinary tract stone disease, the presenting symptoms may not be as classic as in adults, which in turn leads to uncertainty about the best imaging approach [42]. Interestingly, a number of pediatric patients with urolithiasis do not have hematuria [43]. While the incidence of pediatric stone disease is considerably lower than in adults, it is still commonly seen in busy pediatric practices [44]. Affected children may have a family history of nephrolithiasis or predisposing inborn metabolic disease [45,46]. While the literature provides general suggestions and guidelines, universal agreement regarding the imaging procedure of choice in suspected urolithiasis has not been reached. CT CT There is good evidence in adults that CT is the most accurate imaging modality in the identification of stones and the quantification of stone burden, with sensitivity and specificity both well above 90% [44,47-55]. With proper techniques and newer image iterative reconstruction algorithms, the CT dose can be very low and lowered to less than that of a traditional IVU [44,56,57]. Limitations of radiography (eg, small stone size, obscuration of stones by bowel contents) and US (eg, small stone size, obscuration of a portion of the kidney by bowel gas, poor sonographic window) in children do not impair CT evaluation. CT may be particularly useful in the setting of painful hematuria, a negative kidney and bladder US examination, and high clinical suspicion for urolithiasis, particularly if detection would impact treatment. US US of the kidneys and bladder has limited sensitivity in detection of renal and ureteral stones. Palmer et al [49] reported that US found 75% of all urinary tract stones, although US found only 38% of stones within the ureter.