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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical presentation and roentgenographic findings of renal cell carcinoma have been consistently variable. These patients can appear with flank pain mimicking ureteral colic, flank tumors, or symptomatic metastasis [1]. Systemic cardiac manifestations including cardiomegaly with congestive heart failure due to arteriovenous fistula formation have been reported [2] Roentgenographic findings may show the tumor to be either vascular or avascular. It may present as a spontaneous perforation of the pelvic ureteral system which is demonstrated by intravenous pyelography (3). In this article, we describe a case of hypernephroma in a cyst wall causing severe spontaneous hemorrhage in the retroperitoneal space resulting in a state of hypovolemic shock.
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PMID:Spontaneous retroperitoneal hemorrhage from a ruptured hypernephroma. 45 21

18 patients were admitted from 1969 to 1973 to the Surgical and Urological University Clinic in Mainz with ruptured infrarenal aortic aneurysms. Three patients died immediately following the operation and three during surgery from internal hemorrhage. Eight patients died later following prolonged shock. Four patients survived surgery. The classical symptoms of shock, abdominal pain and pulsating tumor was only present in three patients. The diagnosis was only made in seven patients at admission, from the clinical findings. Urological symptoms were also prominent such as unilateral flank pain, colic, dysuria, anuria and tenderness over the kidney. There is no typical clinical picture of ruptured aortic aneurysm. Acute urological symptomatology in cases of acute abdomen with unclear etiology and in connection with shock could indicate a ruptured aortic aneurysm. There is absolute indication for immediate operative intervention. The aneurysm is removed and replaced by a vascular prosthesis. Early diagnosis is important since prolonged shock and anuria will result in a poor postoperative prognosis. Abdominal exploration is therefore also indicated when a ruptured aortic aneurysm is only suspected.
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PMID:[Urinary tract manifestations of ruptured infrarenal aortic aneurysms (author's transl)]. 120 8

One hundred and seven patients with caliceal stones causing flank pain were treated by extracorporeal shock wave lithotripsy (ESWL), followed up and reviewed. The total stone-free rate 3 months after ESWL was 38.8%. The total pain-free rate was 50.5%. The pain-free rate was 85% in the stone-free group and 29% in the group with residual stones. No significant differences between the stone-free rate and the duration of pain or age was noted. Patients with abnormal intravenous pyelography (IVP) had a lower stone-free rate than patients with normal IVP (16 vs. 45%, p less than 0.05). The complications included: 6 cases of stone street formation with spontaneous passage; 1 case of stone street formation needing percutaneous nephrolithotomy for drainage; 1 perirenal hematoma; 9 cases of severe colic pain following ESWL; 3 cases of fever following ESWL, and 4 cases of hydronephrosis due to a stone in the ureterovesicle junction. These results show that ESWL is an effective, noninvasive treatment for painful caliceal stones.
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PMID:Management of painful caliceal stones by extracorporeal shock wave lithotripsy. 226 35

In October 14, 1982, a 30-year-old male was admitted to the hospital because of a left flank pain and melena. On undergoing testing, an upper gastrointestinal series revealed barium retention in the small bowel, in which an abdomen X-p showed an abnormal gas shadow. Endoscopic examinations revealed depressive lesions, and the histological diagnosis was malignant neoplasm with a duodenal wall infiltration. A superior mesentric arteriogram showed the dilatation of the media colic artery and neovascular lesions. Thus a leiomyosarcoma of the small intestine was suspected, and the patient underwent surgery on November 15. The tumor was sack-like and looked black; histologically it was diagnosed as a small intestine, because the primary origin was only detected in the small intestine. Four months after the operation, the tumor recurred and the patient died in June, 1983.
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PMID:[A primary malignant melanoma of the small intestine]. 236 30

An asymptomatic 73-year-old woman was found to have multiple, simultaneous, inverted papillomas of the renal pelvis and ureter. A review of the world literature yielded 34 cases of inverted papillomas in the upper urinary tract: 13 in the renal pelvis, and 21 in the ureter. Among these 34 cases, there were 26 male and five female patients, with gender not given for three others. Patients ranged in age from 19 to 89 years (mean, 64.1 years). Many cases lacked complete clinical details but, among the others, gross painless hematuria was the presenting symptom in seven; hematuria with flank pain or colic in six; and pain without hematuria in six. Only six patients lacked urinary tract symptoms, and three of these had microscopic hematuria. Only two patients had more than one inverted papilloma, and these were not multicentric. Adequate pathologic documentation and follow-up data were, unfortunately, absent in many of the cases. Although inverted papillomas are curable with surgical resection, with a low rate of local recurrence, they appear to be associated with synchronous or asynchronous carcinomas, especially other transitional cell tumors in the urinary tract.
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PMID:Multiple simultaneous inverted papillomas of the upper urinary tract. A case report with a review of ureteral and renal pelvic inverted papillomas. 264 34

The presence of stones during an otherwise uneventful pregnancy is a dramatic and potentially serious issue for the mother, the fetus, and the treating physicians alike. The incidence and predisposing factors are generally the same as in nonpregnant, sexually active, childbearing women. Unique metabolic effects in pregnancy such as hyperuricuria and hypercalciuria, changes in inhibitors of lithiasis formation, stasis, relative dehydration, and the presence of infection all have an impact on stone formation. The anatomic changes and physiologic hydronephrosis of pregnancy make the diagnosis and treatment more challenging. Presenting signs and symptoms include colic, flank pain, hematuria, urinary tract infection, irritative voiding, fever, premature onset or cessation of labor, and pre-eclampsia. The initial evaluation and treatment are again similar to those used for the nonpregnant population. The most appropriate first-line test is renal ultrasonography, which may, by itself, allow the diagnosis to be made and provide enough information for treatment. Radiographic studies, including an appropriately performed excretory urogram, give specific information as to size and location of the stones, location of the kidneys, and differential renal function and can be used safely, but the ionizing radiation risks should be considered. All forms of treatment with the exception of extracorporeal shock wave lithotripsy and some medical procedures are appropriate in the pregnant patient. Close coordination by the urologist, the obstetrician, the pediatrician, the anesthesiologist, and the radiologist is required for the appropriate care of these patients.
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PMID:Urinary tract stones in pregnancy. 785 14

Two adult patients with acute renal vascular occlusion with infarction are described. Both patients were believed to have ureteral colic. In each instance, the correct diagnosis was overlooked at the initial emergency department visit. An uncommon clinical entity that continues to go undiagnosed, acute vascular occlusion of the kidney must be considered in the differential diagnosis of acute flank pain. Absence of the nephrogram phase on an intravenous pyelogram (IVP) should alert emergency physicians to this possible diagnosis and to the need for further work-up. Subsequent diagnostic evaluation should begin with renal ultrasonography to rule out obstructive uropathy. If hydroureteronephrosis is not present, follow-up perfusion studies are necessary to confirm the absence of renal perfusion. Greater awareness of this uncommon clinical entity and its potential morbidity is essential to correct diagnosis and management.
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PMID:Acute renal vascular occlusion: an uncommon mimic. 815 6

By the analysis of the series reported by many authors, urolithiasis in pregnancy seems to be a rare, but significant pathology. The disease, potentially dramatic for the mother and fetus, appearing into a such particular physiological state like is pregnancy, suggests a reevaluation of diagnostic and therapeutic methods and better control of maternal and fetal risk. Furthermore, urolithiasis must be considered as cause of premature birth, a very severe complication of pregnancy the incidence and predisposing factors of urinary tract stones are generally the same in nonpregnant women. But any metabolic effects and the anatomical changes happen in pregnancy can have a important role on stone's formation. Signs and symptoms in urinary stone disease are: colic, flank pain, hematuria, urinary tract infection; irritative voiding, fever. The initial evaluation and treatment are again similar to those used for the non pregnant population. Radiographic studies any way must be used with caution for the risks of the ionizing radiations for the fetus. All forms of treatment with the exception of extracorporeal shock ware lithotripsy, are appropriate in the pregnant patients but naturally very useful, for the appropriate care of these patients is the coordination by the urologist, the obstetrician, the pediatrician, the radiologist and the anesthesiologist.
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PMID:[Review on renal calculosis in pregnancy]. 952 3

The objective of this study was to determine whether helical computed tomography (CT) performed without oral or intravenous contrast agents is accurate in the evaluation of patients with suspected acute renal colic. One hundred consecutive patients with suspected renal colic or ureteral colic were referred by our institution's emergency department for unenhanced helical CT scans. We reviewed the original radiographic report for each patient and recorded the size and location of ureteral calculi and other concurrent urinary tract calculi, if any. We also recorded the presence or absence of hydronephrosis, hydroureter, perinephric edema, and periureteral edema. A total of 49 patients had ureteral calculi, 17 patients had only renal calculi, and 34 patients had no stones. Forty-nine patients had ureteral calculi, and 40 (82%) of these 49 patients had associated CT signs including hydroureter and periureteral edema. Calculi were present in the proximal ureter in 11 patients, the midureter in seven patients, and the distal ureter including ureterovesical junction in 31 patients. Calculi were seen elsewhere in the urinary tract and renal pelvis in 44 patients. Other diagnostic tests and stone passage were used to confirm the CT diagnosis of ureteral stones. The sensitivity and specificity of helical CT in evaluating ureteral calculi were 100% and 94%, respectively. Sixteen extraurinary lesions were detected in 34 patients who had no urinary calculi. Most extraurinary lesions (81%) were deemed the cause of acute flank pain. The room time for CT averaged 26 min, compared to 69 min for intravenous urography (IVU). The charge for CT was $600 compared to $400 for IVU in our institution. Unenhanced helical CT was fast and accurate in determining the cause of colic and proved to be highly accurate for emergency situations.
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PMID:Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic? 1019 91

The use of noncontrast helical CT (NHCT) to assess patients with acute flank pain and hematuria for potential urinary tract stone disease was first reported in 1995. After several years of experience with the technique, sensitivity and specificity of NHCT has proven to be better than intravenous urography for evaluating ureteral stones. NHCT imaging findings for urinary calculi and the differential diagnosis are discussed in this article. Various extraurinary diseases found while using NHCT in searching for stone disease are addressed and illustrated. As experience with the use of NHCT has increased, clinicians have broadened the indications for this technique, which has a lower charge than standard CT, beyond the specific evaluation of urinary colic. This indication creep has increased the number of NHCT examinations ordered. It has also reduced the rate of stone positivity and increased the diagnostic yield for extraurinary disease.
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PMID:CT diagnosis of acute flank pain from urolithiasis. 1068 64


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