FLANK PAIN

Most cases of flank pain are associated with inflammation of the kidney. As is shown in Table 29, however, jumping to that conclusion in any given case may be hazardous.

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FLANK PAIN

	V	I	N	D
	Vascular	Inflammatory	Neoplasm	Degenerative
Skin		Cellulitis Herpes zoster
Muscle and Fascia		Trichinosis
Colon	Mesenteric thrombosis	Colitis	Carcinoma
Gallbladder		Cholecystitis Cholangitis	Carcinoma
Adrenal Gland
Kidney	Embolism Thrombosis	Pyelonephritis Perinephric abscess	Wilms tumor Hypernephroma
Aorta	Aneurysm			Atheroma Dissecting aneurysm
Vena Cava	Thrombosis
Spine		Osteomyelitis Tuberculosis	Metastatic carcinoma	Osteoarthritis
Spinal Cord and Nerves	Anterior spinal artery occlusion	Tabes dorsalis Myelitis Epidural abscess	Spinal cord tumor

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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. -4pc

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FLANK PAIN

I	C	A	T	E
Intoxication	Congenital Acquired	Autoimmune	Trauma	Endocrine
Idiopathic	Malformation
			Contusion Laceration
	Hernia	Dermatomyositis	Contusion
	Diverticulitis Appendix	Ulcerative colitis Granulomatous colitis	Contusion Laceration
				Hemorrhage Infarction Tumor
Gout Toxic nephritis Crush syndrome	Obstruction Infection due to malformation	Periarteritis nodosa Vasculitis of other cause	Contusion Laceration	Calculus due to hyperparathyroidism
			Rupture
		Marie–Strümpell disease	Fracture Herniated disc
Arsenic poisoning Porphyria	Syringomyelia	Guillain–Barré syndrome	Hematoma

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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. 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.

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)

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Abdominal pain: Introduction (review 2415 causes)
• Next Book Extract About Abdominal pain: Abdominal Mass, Generalized (Differential Diagnosis in Primary Care)
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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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