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Flank Pain Imaging

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History of Present Illness:

A 32-year-old female presents to the ED for 3 hours of right flank pain that resolved spontaneously after arrival to triage.    She also had one episode of vomiting and a period of urgency towards the end which resolved as well.  She denies any fever or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is normal

Initial Differential Diagnosis:

  • Pyelonephritis
  • Kidney stone
  • Ectopic
  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • EKG: none
  • Labs: UA shows RBC’s but no bacteria or WBC’s
  • Imaging: none

QUESTIONS:

  1. What is the imaging study of choice for this patient?  
  2. Want a 1-minute consult/tutorial on this case? 
  3. Want to know what happened with this patient?

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWERS:

  1. What is the imaging study of choice for this patient?  The retina.  Have her pee in a strainer.  Since the pain just recently resolved, there may be a kidney stone waiting in the bladder.  (See below)
  2. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  3. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: See the kidney stone below

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