Symptom Finder - Flank Pain
FLANK PAIN
Most cases of flank pain are associated with inflammation of the kidney. however, jumping to that conclusion in any given case may be hazardous. In addition to the kidney (pyelonephritis and perinephric abscess), inflammation of the skin (herpes zoster), the colon (diverticulitis and colitis), the gallbladder (cholecystitis), and the spine (epidural abscess and Pott disease) may also cause flank pain. The mnemonic VINDICATE also suggests several vascular disorders that are significant causes of flank pain such as aortic aneurysms, embolic nephritis, and mesenteric thrombosis. Neoplasms of the kidney and colon are less likely to produce pain unless they are complicated by infection. However, trauma of the kidney and spine and renal calculi—whether due to hyperparathyroidism, idiopathic etiologies, or hyperuricemia—are important causes. Neoplasms of the spinal cord and tabes dorsalis must also be considered.
Table
Approach to the Diagnosis
The diagnosis of flank pain usually involves careful examination of the urine and a urine culture, an IVP, and plain films of the abdomen and spine. When the patient is pregnant, ultrasonography can be done. If these are negative, bone scans, arteriogram, and other tests listed below may be required. CT has eliminated the need for exploratory laparotomy in many cases. Recently MR or CT urography has been introduced and may be even more definitive. Noncontrast helical CT scan has the greatest specificity for renal stones (95% to 100%).
Other Useful Tests
1. Urology consult
2. Neurology consult
3. CBC
4. Chemistry panel (uremia, renal calculi)
5. CT scan of the abdomen and pelvis (neoplasms, stones,
hemorrhage abscess)
6. X-rays of the thoracolumbar spine (bone metastasis, herniated
disc)
7. MRI of the thoracic spine (neoplasms, herniated disc)
8. Sonogram (renal cyst)
9. Urine for acid-fast bacillus (AFB) smear and culture (tuberculosis)
10. Cystoscopy and retrograde pyelography (malformations, neoplasm)
11. Protein electrophoresis (multiple myeloma)
Most cases of flank pain are associated with inflammation of the kidney. however, jumping to that conclusion in any given case may be hazardous. In addition to the kidney (pyelonephritis and perinephric abscess), inflammation of the skin (herpes zoster), the colon (diverticulitis and colitis), the gallbladder (cholecystitis), and the spine (epidural abscess and Pott disease) may also cause flank pain. The mnemonic VINDICATE also suggests several vascular disorders that are significant causes of flank pain such as aortic aneurysms, embolic nephritis, and mesenteric thrombosis. Neoplasms of the kidney and colon are less likely to produce pain unless they are complicated by infection. However, trauma of the kidney and spine and renal calculi—whether due to hyperparathyroidism, idiopathic etiologies, or hyperuricemia—are important causes. Neoplasms of the spinal cord and tabes dorsalis must also be considered.
Table
Approach to the Diagnosis
The diagnosis of flank pain usually involves careful examination of the urine and a urine culture, an IVP, and plain films of the abdomen and spine. When the patient is pregnant, ultrasonography can be done. If these are negative, bone scans, arteriogram, and other tests listed below may be required. CT has eliminated the need for exploratory laparotomy in many cases. Recently MR or CT urography has been introduced and may be even more definitive. Noncontrast helical CT scan has the greatest specificity for renal stones (95% to 100%).
Other Useful Tests
1. Urology consult
2. Neurology consult
3. CBC
4. Chemistry panel (uremia, renal calculi)
5. CT scan of the abdomen and pelvis (neoplasms, stones,
hemorrhage abscess)
6. X-rays of the thoracolumbar spine (bone metastasis, herniated
disc)
7. MRI of the thoracic spine (neoplasms, herniated disc)
8. Sonogram (renal cyst)
9. Urine for acid-fast bacillus (AFB) smear and culture (tuberculosis)
10. Cystoscopy and retrograde pyelography (malformations, neoplasm)
11. Protein electrophoresis (multiple myeloma)
