A 32-year-old woman with flank pain, hematuria, and palpable kidneys has a family history suggestive of autosomal dominant polycystic kidney disease. What diagnostic study is indicated at this time?

• A. CT scan
• B. Excretory infusion urography
• C. KUB radiograph
• D. Ultrasound

Answer: (A)

In a patient with suspected autosomal dominant polycystic kidney disease who presents with flank pain, hematuria, and palpable kidneys, the priority is to obtain imaging that offers detailed, rapid visualization of the renal parenchyma and any acute problems. CT scanning provides high-resolution cross-sectional images that can reveal the presence and extent of renal cysts, differentiate simple from complex cysts, and detect complications such as hemorrhage, infection, stones, or obstruction. This level of detail helps confirm the diagnosis in the setting of a strong family history and palpable kidneys and also guides urgent management if an acute process is present.

Ultrasound, while useful as an initial screening test for polycystic kidney disease and for evaluating kidneys without radiation exposure, can be less sensitive for small cysts or complex cyst morphology and may miss subtle findings in the acute setting. Excretory urography and KUB radiographs have limited utility for polycystic disease and are not as informative about cyst structure or complications.

Thus, CT scan is the most informative choice in this scenario because it rapidly provides comprehensive assessment of cystic kidney disease and any concurrent acute issues.