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

Two patients with renal arteriovenous malformations are presented along with the distinct changes shown by urography, arteriography, and pharmacoangiography. The relevant roentgen signs in such patients include multiple small cobblestone-like identations caused by well-formed vascular channels projecting into the collecting structures, no angiographic or urographic evidence of a mass displacing the intrarenal vessels or collecting structures, normal sized arteries and veins leading to and from the malformation, and a decrease in size of the malformation after intra-arterial infusion of epinephrine. These patients may have flank pain or hematuria later in life or may remain asymptomatic. A complete urographic and angiographic examination will help to determine the appropriate therapy. Corrective surgery is usually reserved for symptomatic patients and, when indicated, require only surgical ligation of the vessels feeding and draining the malformation.
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PMID:Congenital renal arteriovenous malformation: angiography in its diagnosis. 111 74

Urinary tract stones were present in 41 patients out of 54 who presented with recurrent or persistent flank pain. Ultrasound showed pelvicaliceal dilatation in 95.1% of these patients. Ultrasound is a safe, quick, reliable and cost effective diagnostic tool in such cases. Intravenous urography should be reserved for cases which need surgical intervention.
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PMID:Value of ultrasound in persistent flank pain. 177 26

Pheochromocytoma is an unusual but potentially devastating tumor. Although a high index of suspicion is necessary, the likelihood of a pheochromocytoma is lower in the absence of the typical symptoms and findings. Nonetheless, screening must be broadened to include patients with a lower risk of the disease, such as those with resistant or labile hypertension who are minimally symptomatic. Extensive diagnostic evaluations should be reserved for those whose clinical or laboratory findings are more suggestive. Symptoms in a group of patients in whom a pheochromocytoma was seriously considered but excluded overlap symptoms in patients with a pheochromocytoma. Certain symptoms are useful: flushing to suggest a non-pheochromocytoma illness; visual symptoms, flank pain, and pallor to suggest that a pheochromocytoma is more likely. Combinations of symptoms can be of value: 2 or more symptoms from the triad of headache, palpitations, and diaphoresis were present in the majority of pheochromocytoma patients, but in a smaller number of non-pheochromocytoma patients. The presence of the entire triad is more specific, but less sensitive. New hypertension, or hypertension associated with unexplained orthostatic hypotension, are suggestive of an underlying pheochromocytoma. Twenty-four-hour urine studies are consistently abnormal in patients with a pheochromocytoma, but are also elevated in a significant proportion of non-pheochromocytoma patients. Values greater then 1.5-2-fold above the upper limit of normal are very suggestive that a pheochromocytoma is present, and warrant a more intensive subsequent evaluation. Imaging studies are reliable in the diagnosis of pheochromocytoma, and can help to confirm or exclude the disease. Patients with a higher clinical likelihood and any elevated urinary testing, or with a lower clinical likelihood and persistently and/or significantly elevated urinary testing, should have imaging studies performed. This combination of clinical screening, 24-hour urinary testing, and imaging studies is a useful and reliable approach to patients suspected of harboring a pheochromocytoma.
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PMID:A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. 198 66

A five year experience with spontaneous perirenal hemorrhage at the Brigham and Women's Hospital was reviewed, with 15 instances identified. Ages ranged from 17 to 80 years (mean of 56 years). Abdominal or flank pain was the presenting symptom in 13 patients; one patient was in a state of shock. Anemia and elevation of lactate dehydrogenase were uniformly present during acute evaluation. Computerized tomography (CT) identified lesions other than hematoma in ten of 14 instances. Arteriography was essential to the diagnosis of two vascular lesions not appreciated by other imaging modalities. Intravenous pyelography and ultrasound did not add significantly to findings on CT or arteriography. Six patients underwent serial CT evaluation; three with persistent nonfatty lesions had carcinoma of the kidney confirmed at operation. Carcinoma of the kidney occurred in a total of eight patients and angiomyolipoma in three patients. It was suggested that patients with clinical evidence for spontaneous perirenal hemorrhage should be evaluated by CT, with arteriography added when the underlying cause remains uncertain. Nephrectomy should be performed for CT evidence of nonfatty lesions other than hematoma. Other patients may have serial CT with nephrectomy reserved for persistent abnormalities. The protocol decreases the likelihood of nephrectomy for benign disease while addressing the high incidence of carcinoma of the kidney among patients with spontaneous perirenal hemorrhage.
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PMID:Rational approach to evaluation and management of spontaneous perirenal hemorrhage. 230 Aug 64

Renal artery embolectomy was performed on four patients. There was no operative mortality. Four of the five affected kidneys were salvaged. The most common initial symptom was flank pain. The literature from 1970 to 1982 was reviewed to determine the current operative mortality (11%) and frequency of kidney salvage (67% to 90%) with surgery or anticoagulation. Newer treatment modalities, including intraarterially injected low-dose streptokinase and percutaneous transluminal angioplasty, have also proved useful. The addition of these newer methods, combined with the fact that kidneys can frequently be salvaged after prolonged periods of acute renal artery occlusion, led to the development of a clinical algorithm for treatment. With this algorithm, surgical embolectomy was reserved for patients with total renal parenchymal compromise caused by emboli, whose conditions failed to respond to less invasive treatment modes.
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PMID:Treatment of renal artery embolism. 623 69

In 58 patients with acute recurrent or persistent flank pain, straight x-ray (kidney, ureter, bladder region) detected stones in the urinary tract in 50 cases (86.2%), whereas ultrasonography detected stones in the urinary tract in 55 patients (94.8%). Ultrasound also detected unilateral hydronephrosis in 20 patients (34.48%). The presence of calculus was subsequently proved by intravenous urography/surgery or spontaneous passage. Ultrasonography is safe, quick, reliable and most effective diagnostic tool in such cases in rural areas. Intravenous urogram should be reserved for cases which need surgical intervention.
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PMID:Ultrasonography in acute flank pain. 914 63

The aim of our study was to compare the accuracy of non-contrast spiral CT with ultrasound (US) for the diagnosis of ureteral calculi in the evaluation of patients with acute flank pain. 62 consecutive patients with flank pain were examined with both CT and US over a period of 9 months. All patients were prospectively defined as either positive or negative for ureterolithiasis, based on follow-up evaluation. 43 of the 62 patients were confirmed as having ureteral calculi based on stone recovery or urological interventions. US showed 93% sensitivity and 95% specificity in the diagnosis of ureterolithiasis; CT showed 91% and 95%, respectively. Pathology unrelated to urinary stone disease was demonstrated in six patients. Although both modalities were excellent for detecting ureteral stones, consideration of cost and radiation lead us to suggest that US be employed first and CT be reserved for when US is unavailable or non-diagnostic.
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PMID:Ultrasound vs CT for the detection of ureteric stones in patients with renal colic. 1167 5

Urolithiasis is a very common affliction of mankind. In western countries incidence is increasing steadily. An increasing proportion of patients are presenting with ureteral stones, of which renal colic most often is the first complaint and the most common reason for an emergency visit to a urologist. Proper imaging strategy is of paramount importance in the diagnosis of acute flank pain and in the subsequent therapy planning once a ureteral stone is diagnosed. Renal colic during pregnancy poses specific problems, both in imaging and therapy. Apart from the adequate treatment of renal colic, modern therapy of those ureteral calculi that will not pass spontaneously will consist of a judicious combination of ESWL (extracorporeal shock wave lithotripsy), endourology, and laparoscopy. Open surgery should only be reserved for limited and very specific indications. Although beyond the scope of this article, metaphylaxis should take an important role in the follow-up of stone patients in general.
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PMID:Modern approach to ureteral stones. 1453 25

The diagnosis of acute pyelonephritis in adults is predominantly made by a combination of typical clinical features of flank pain, high temperature and dysuria combined with urinalysis findings of bacteruria and pyuria. Imaging is generally reserved for patients who have atypical presenting features or in those who fail to respond to conventional therapy. In addition, early imaging may be useful in diabetics or immunocompromised patients. In such patients, imaging may not only aid in making the diagnosis of acute pyelonephritis, but more importantly, it may help identify complications such as abscess formation. In this pictorial review, we discuss the role of modern imaging in acute pyelonephritis and its complications. We discuss the growing role of cross-sectional imaging with computed tomography (CT) and novel magnetic resonance imaging (MRI) techniques that may be used to demonstrate both typical as well as unusual manifestations of acute pyelonephritis and its complications. In addition, conditions such as emphysematous and fungal pyelonephritis are discussed.
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PMID:Imaging of acute pyelonephritis in the adult. 1693 2

Bilateral emphysematous pyelonephritis is a rare life-threatening condition affecting almost exclusively patients with diabetes mellitus. Symptoms, which include fever, chills, abdominal and flank pain, nausea, vomiting, dysuria and pyuria, usually mimic those of classic pyelonephritis, and thus clinical suspicion for this urgent condition should be raised in every diabetic patient with similar presentation. Computed tomography (CT) remains the gold standard for the diagnosis demonstrating gas in the renal parenchyma, collecting system or perinephric tissue. Treatment, which should be aggressive, is classically surgical, and early nephrectomy is recommended. Percutaneous drainage associated with medical treatment might be an alternative. Successful exclusively medical treatment has been described but is infrequent and is reserved as an alternative for patients in whom surgical intervention is contraindicated. We report a case of bilateral emphysematous pyelonephritis in an 82-year-old female diabetic patient who presented with symptoms of typical pyelonephritis. Diagnosis was confirmed by CT, and Escherichia coli was identified as the causative factor. The patient was successfully treated medically with intravenous administration of cefepime and amikacin for 14 days and recovered fully. The therapeutical options for this severe but rare condition are discussed.
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PMID:Nonsurgical treatment of bilateral emphysematous pyelonephritis in a diabetic patient. 1713 98


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