LAUSR

Dear Editor I read with interest, the first of the SONO case series by William Shyy and Roneesha Knight. I would like to make a few comments about the article and the proposed algorithm. 1. The advantage of noncontrast lowdose CT scan is its ability to measure the size and location of the calculus. This is important for an emergency physician who has to determine patient’s disposition and access to further treatment. Patients with small stones (<6 mm) and pain resolution can be safely discharged home. Whereas those with a large calculus will need a more urgent followup or immediate hospital admission. In most cases, a CT scan is required in this decision process. 2. It is important to note that nephrolithiasis can be present with very mild or no dilatation of the renal drainage system especially in partial obstruction and those who presents early. The absence of dilatation, therefore, does not rule out nephrolithiasis and further investigation is warranted. 3. Finally, it must be stressed that for the emergency physician, the utility of point of care ultrasound(PoCUS) in this instance is in making a quick rule in diagnosis for the cause of abdominal pan. Patients with positive findings of obstructive ureterolithiasis can be quickly and safely triaged into a renal colic fast track such as the one suggested by Al Kadhi.