Acute Flank Pain in a Young Woman: What's Your Dx?
Right-sided flank pain of 3h duration is the presenting complaint of a 32-year-old woman with no relevant medical history. She claims 1 episode of vomiting. What can you see on CT abdomen?
A Young Woman with Acute Right Flank Pain: What's your Diagnosis?
History of Present Illness. Patient arrives at ED complaining of 3h of right flank pain that has resolved. She reports having vomited once.
History, Physical, and Diagnostic Testing. Results of physical examination are normal and vital signs also are normal.
What does the CT abdomen show? Hydronephrosis? Gallstone? Pyelonephritis? Or, none of these?
Results of the abdominal CT scan are normal. It would be prudent to image the retina at this point and to have her pee into a strainer -- in case of kidney stones that may be waiting in the bladder. In this case, there was one.
Imaging for Flank Pain Depends on Many Factors. When there is high diagnostic certainty for an uncomplicated kidney stone or uncomplicated pyelonephritis, formal imaging is often not necessary and if opted for, an ultrasound is probably preferred to avoid radiation.
Strong Indications for Imaging. When there is clinical concern for abdominal aortic aneurysm , appendicitis, or other condition where watchful waiting may be dangerous The same is true when there is clinical concern for an infected kidney stone or a suspicious urinalysis that contains a concerning number of white cells (typically > 10-20) and/or bacteria.
For additional information, please see highlighted section of sample page on the last slide.
RENAL STONES from The Emergency Medicine 1-Minute Consult Pocketbook
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