Tiny Kidney Stone?

Discussion in 'Medical Topics' started by Fletch F Fletch, Feb 26, 2021.

  1. Hello all,

    I wound up getting a CT for something unrelated (which turned out to be nothing), but in the process, the Radiologist picked out a 1mm "faint calcification". An "incidental finding" I think they call it. I wouldn't have even known about it had I not actually requested/read the report/images because the Doc never told me about it.

    Reading through the CACI guidelines, it talks about getting a note from the physician, which is fine, but if it was the first finding, can the Dr sign off that it's "stable and unchanging?" with only one image. Do I need to get a second scan of some kind (US, XRay or another CT), and if so, what would be the time interval?

    Just trying to do my homework since my medical is due next month. I did do a search of the forum, but didn't see anything 100% relevant.

    Appreciation in advance.
     
  2. murphey

    murphey Touchdown! Greaser! PoA Supporter

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    Good reason for an AME consultation to find out what (if any) additional tests and documentation you'll need before the official AME visit.
     
  3. Initial Fix

    Initial Fix Pre-takeoff checklist

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    Been there. Passed a stone too.

    It was a non issue for me. Just a follow up report from my doc attached to my class 2 medical once a year for two years.
     
  4. Half Fast

    Half Fast Final Approach

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    OTOH, kidney stones do not require an SI under Basic Med. Something to consider if the Basic Med limitations will work for you.
     
  5. bbchien

    bbchien Touchdown! Greaser!

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    Bruce C
    Try this: the urologist might feel that it's parenchymal and just not going to be a factor.
    Otherwise for a retained stone, recent, you do indeed, need two images 90 days apart.
     

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  6. Thanks Dr. B. That was the information I was looking for.
     
  7. Another Guy

    Another Guy Guest

    Are retained stones the only ones the FAA is concerned about?
     
  8. Cervieres

    Cervieres Pre-takeoff checklist

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    Antione
    If follow-up imaging is required, inquire as to whether you can substitute a renal ultrasound for a CT. Even if still present, a 1mm "faint" calcification seen on CT will likely be below the resolution of ultrasound. Also consider increasing your fluid intake. If it is a 1mm urinary tract calculus, it may pass without your knowledge.
     
  9. murphey

    murphey Touchdown! Greaser! PoA Supporter

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    >ultrasound
    in other words, game the system?

    Imaging is usually a KUB for the stone. BTDT.
     
  10. Cervieres

    Cervieres Pre-takeoff checklist

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    Not gaming the system. CT identified an incidental and likely inconsequential finding that unfortunately requires further work up. Ultrasound is the most cost effective and safe modality in this case. In an asymptomatic individual, a negative renal ultrasound ensures very little chance of clinically significant stone disease or urinary tract obstruction. I just don’t know if the FAA would agree, or require another CT stone protocol.

    In 1980, KUB would have been a great answer. If your physician is currently recommending KUB only for evaluation of renal calculus, you should find a new one who keeps up with practice guidelines.
     
  11. murphey

    murphey Touchdown! Greaser! PoA Supporter

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    The physicians who required the KUB were 1) urologist and 2) nephrologist. Somehow, I think both are up to date with practice guidelines.
     
  12. Jeff Oslick

    Jeff Oslick En-Route

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    If you do need a follow-up CT, call around to local clinics for pricing. There can be a huge variation in cost, and your insurance may not cover it because for a 1 mm stone I doubt they'd consider it medically necessary.
     
  13. danhagan

    danhagan Pattern Altitude

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    I'm in medical imaging. Ultrasound in "the wrong hands" often over calls renal calculi. By ultrasound, that echogenic focus is supposed to have distal acoustic shadowing ... many "little white dots" do not have shadowing and a large number of them would be more accurately classified as "focal fibrosis" or scarring secondary to some previous infection.

    We get a fair number of ATP pilots that get to see the scenery on this road. CT scan using renal calculi protocol if needed, and the rest of the stuff Dr Bruce indicated ....