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September 10, 2013

Caution – kidney stone diagnosis may miss more deadly conditions

Two weeks ago, I started on the issue of kidney stones and their diagnosis. Since then, I have been down with the “flu” and a subsequent cough, which made it impossible to write. To summarize, I said that kidney stones, which cause pain, are not diagnosed solely by an ultrasound or x-ray, but mainly by a doctor taking the time to elicit the appropriate history and do a clinical examination.{{more}}

An ultrasound result is dependent on the doctor making the request and the one doing the test. I also said that a machine cannot replace a doctor, because ultrasounds and x-rays do not examine patients, they only help in making the diagnosis, but many a time can be misleading and even deadly! I know this sounds alarming, but let me explain.

The patient has pain; the doctor not taking the time to examine the patient and elicit a good history, diagnoses a kidney stone. He sends the patient for an ultrasound or X-ray of the abdomen and informs the radiologist that he is suspicious of a stone in the kidney. The radiologist sees a stone and the doctor assumes that this stone is causing the pain, but it might not be. In my experience, it usually isn’t. It is usually something else. These other things are called differential diagnoses. It can be a muscular strain, a leaking aortic aneurysm or balloon, a chest infection, a gall bladder obstruction or infection, bowel infection, obstruction or cancer, a stomach ulcer or cancer or shingles to name a few.

The problem with the above list (and I said it’s a few) is that some of the differential diagnoses are life-threatening and if missed for a long period, may cause death. All doctors at some point in their lives have misdiagnosed patients, but it becomes less common as we mature in experience, hence the reason why I always say that being a doctor is like fine wine. One gets better the more experience one has. So, you ask why didn’t the radiologist detect the other conditions that might be life-threatening.
 
The answer is simple: the radiologist is not your primary doctor and he or she is simply carrying out the request made by your doctor who should have taken the time to examine you properly and made a good diagnosis. In other words, if your doctor gets the diagnosis wrong, then he or she asks for the “wrong” tests. The test result may be correct, but it does not help you. Sometimes the radiologist is able to detect the other pathology and sometimes the absence of the “kidney stone” prompts the doctor to re-examine his diagnosis and ask for other tests, but the main point is, don’t be quick to accept a diagnosis of kidney stones as other more deadly conditions may be missed.

I am passionate about this diagnosis of a kidney stone, because every day I see patients with chronic pain diagnosed as kidney stones for months to years, only to find another diagnosis causing their pain. I have also seen patients whose appendix was removed, only for the pain to recur and a diagnosis of kidney or ureteral stone made.

I have seen a patient diagnosed with kidney stones that turned out to be a cancer in the left side of his colon. This is rare, but it’s more common to diagnose stomach problems and muscular strains.

Next week, I will look at the treatment of kidney stones.

For comments or question contact:

Dr Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com

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