Flank Pain

Aka: Flank Pain, Costovertebral Angle Tenderness, CVA Tenderness

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II. Differential Diagnosis

  1. Renal Causes
    1. Ureterolithiasis (60% of acute Flank Pain presentations)
    2. Pyelonephritis
    3. Renal Mass (e.g. Renal Cell Carcinoma)
    4. Renal Vein Thrombosis
    5. Renal Infarction
  2. Intraabdominal Cause
    1. Abdominal Aortic Aneurysm
      1. Represents 1-2% of Flank Pain presentations (often initially misdiagnosed as Renal Colic)
      2. Marston (1992) J Vasc Surg 16(1): 17-22 [PubMed]
    2. Small Bowel Obstruction
    3. Pancreatitis
    4. Ascites
  3. Right sided Flank Pain
    1. Cholecystitis or Biliary Colic (right sided Flank Pain)
    2. Appendicitis
    3. Peptic Ulcer Disease
  4. Referred pain from Pelvis
    1. Dysmenorrhea
    2. Ovarian Torsion
    3. Ectopic Pregnancy
    4. Ruptured Ovarian Cyst
    5. Testicular Torsion
  5. Referred pain from chest
    1. Pulmonary Embolism
    2. Pneumonia
    3. Rib Contusion or Rib Fracture
  6. Skin and Musculoskeletal
    1. Lumbar back pain (e.g. latisimus dorsi strain)
    2. Herpes Zoster

III. References

  1. Koroglu (2004) Emerg Radiol 10(6): 327-33 [PubMed]
  2. Yew (2023) Am Fam Physician 107(6): 585-96 [PubMed]

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