How is abdominal aortic aneurysm (AAA) differentiated from nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

From the point of view of the emergency department (ED) physician, making the diagnosis of a renal or ureteral stone and excluding appendicitis or abdominal aortic aneurysm (AAA) is sufficient. A urologist, who must ultimately make the decision about possible surgery, may require additional information. Before such a decision can be made, a urologist must know about the size, orientation, radiolucency, composition, and location of the stone and must know about overall kidney function, the presence of any infection, and other clinical information.

Beware of the patient older than 60 years with an apparent first kidney stone. Consider the possibility of symptomatic AAA in the older patient, and rule out this possibility before pursuing the diagnosis of nephrolithiasis. Use bedside ultrasonography if the patient’s condition is potentially unstable. CT scan is a reasonable alternative in the stable patient.


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