FLANK PAIN

Ask the Following Questions:

1. Is there associated fever? The presence of fever along with chest pain should make one think of a perinephric abscess or pyelonephritis. Occasionally, however, hypernephroma can cause fever and flank pain, as can bilateral hydronephrosis.
2. Is there a flank mass? The presence of flank pain along with a flank mass should make one think of a hypernephroma, hydronephrosis, polycystic kidneys, or perinephric abscess.
3. Is there hematuria? The presence of pain and hematuria should make one think of renal calculus first, but the possibility of a renal infarction, polycystic kidneys, and tuberculosis of the kidneys must be considered also. Hematuria is also found in a hypernephroma.

DIAGNOSTIC WORKUP

Routine tests include a CBC, sedimentation rate, chemistry panel, urinalysis, and urine culture. An intravenous pyelogram is the next logical step. If these fail to make a definitive diagnosis, one should consider ordering an abdominal ultrasound or a CT scan of the abdomen. If a renal infarction is suspected, aortography and renal angiography may be ordered. When the above tests are all negative, one should consider x-rays of the lumbosacral spine and MRI of the thoracic and lumbar spine. Consulting a urologist is prudent before ordering expensive diagnostic tests.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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