[SOP Leading symptom: flank pain]. / SOP Leitsymptom Flankenschmerzen.

In addition to triggers such as ureteral stones or pyelonephritis, the common symptom of flank pain can be associated with a whole range of conditions. This SOP is intended to give doctors in the emergency department an overview of the possible causes. Based on medical history, clincal examination including sonography and laboratory diagnostics, important differential diagnoses are addressed and an imaging algorithm is presented.

Xanthogranulomatous Pyelonephritis: Case Report.

BACKGROUND: In the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis. CASE REPORT: A 30-year-old male patient presented to the ED for evaluation of right-sided abdominal pain that has been ongoing for the past 24 hours. He noted the pain was located predominantly in the right flank and described it as sharp in nature. The pain was nonradiating and was associated with scant hematuria. He stated that he had similar pains approximately 1 month earlier that resolved after a few days. The patient underwent a bedside ultrasound and a subsequent computed tomography (CT) scan of the abdomen and pelvis, which showed an enlarged, multiloculated right kidney with dilated calyces and a large staghorn calculus, findings that represent XGP. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights an unusual variant of pyelonephritis, a relatively common ED diagnosis. XGP should be considered in patients with recurrent pyelonephritis, as treatment for XGP may require surgical intervention in addition to traditional antibiotic management.

Wunderlich syndrome in a patient with pyelonephritis.

An elderly female patient with left pyelonephritis developed worsening left flank pain, hypotension and a drop in haemoglobin (Hb) from 97 g/L to 67g/L on the third day of her admission. There was no recent trauma, history of coagulopathy or risk factors for renal malignancy or vascular disease.A contrasted CT scan of the kidneys revealed a 3.8 cm left renal subcapsular haematoma with no active contrast extravasation. Her atraumatic subcapsular haematoma fulfils two out of three clinical features of Lenk's triad (acute flank pain, hypovolaemic shock), suggestive of Wunderlich syndrome. Urine and blood cultures grew Klebsiella pneumoniae and she was managed conservatively with culture-directed antibiotics, fluids and blood products.Wunderlich syndrome is a rare complication of pyelonephritis and should be considered in patients with pyelonephritis who develop acute severe flank pain, Hb drop and haemodynamic instability. Appropriate medical and surgical therapies need to be instituted early to ensure good outcomes.

Treatment of Nutcracker Syndrome with Left Renal Vein Transposition and Endovascular Stenting.

BACKGROUND: Nutcracker syndrome is a rare condition that occurs as a result of the entrapment of the left renal vein (LRV) between the aorta and the superior mesenteric artery. It is typically associated with symptoms such as left flank pain, hematuria, proteinuria, and pelvic congestion. The current treatment approach may be conservative in the presence of tolerable symptoms, and surgical or hybrid and stenting procedures in the order of priority in the presence of intolerable symptoms. The aim of this study is to review our experiences to evaluate the results of both methods in this series in which we have a greater tendency toward surgery instead of stenting. METHODS: The clinical data of consecutive patients with nutcracker syndrome who underwent LRV transposition and LRV stenting between July 2019 and October 2023 were retrospectively reviewed. The patients were divided into 2 groups based on the methods of treatment: surgical and stenting. For procedure selection, LRV transposition was primarily recommended, with stenting offered to those who declined. Primary end points were morbidity and mortality. Secondary end points included late complications, patency, freedom from reintervention, and resolution of symptoms. Standard basic statistics and survival analysis methods were employed. RESULTS: Nineteen patients with nutcracker syndrome (female: 100%) were treated with LRV stentings (n = 5) and LRV transposition (n = 14). The mean age was 24 (20-27, interquartile range [IQR]) years. The mean follow-up was 23 (9-32, IQR) months. There were no major complications and mortality after both procedures. The most frequent sign and symptom associated with LRV entrapment were left flank pain 100% (n = 19), proteinuria 88% (n = 15), and hematuria 47% (n = 9). The mean peak velocity ratio on Doppler ultrasound was 6.13 (6-6.44, IQR). Aortomesenteric angle, beak angle (beak sign), and mean diameter ratio on computed tomography were 26° (22.6-28.5, IQR), 25° (23.9-28, IQR), and 5.3 (5-6, IQR), respectively. Venous pressure measurements were only used to confirm the diagnosis in 5 patients in the stenting group. The measured renocaval gradient was 4 (3.9-4.4, IQR) mm Hg. After both procedures, the classical symptoms, including left flank pain, proteinuria, and hematuria, resolved in 89.5% (n = 17), 57.8% (n = 11), and 82.3% (n = 15) of the cases, respectively. A total of 4 patients required reintervention, 3 patients after LRV transposition (occlusion, n = 2; stenosis, n = 1), and 1 patient after stenting (occlusion, n = 1). The 1-year and 3-year primary patency for the 19 patients was 87% and 80%, respectively. Three-year primary-assisted patency was 100%. Similarly, the 1-year and 3-year freedom from reintervention rate was 83% and 72%, respectively. Additionally, the 1-year and 3-year primary patency for the surgical group was 91% and 81%, respectively, and the 1-year and 3-year primary patency for the stenting group was 75%. CONCLUSIONS: Nutcracker syndrome should be kept in mind in cases where flank pain and hematuria cannot be associated with kidney diseases. Radiographic evidence must be accompanied by serious symptoms to initiate the treatment of nutcracker syndrome with LRV transposition and endovascular stenting procedures. Both procedures, along with their respective advantages and disadvantages, can be preferred as primary treatments for nutcracker syndrome. Our study demonstrates that both procedures can be safely and effectively performed, yielding good outcomes.

A Rare Case of Page Kidney in a Young Man with Flank Pain.

BACKGROUND: Page kidney is a rare condition in which an external compression of the kidney as a result of a hematoma or mass causes renal ischemia and hypertension. In a patient with flank pain, elevated blood pressure, and recent trauma, this condition should be considered. Since this condition was first described in 1939, more than 100 case reports have surfaced. CASE REPORT: We describe the case of a 26-year-old man who presented to the Emergency Department with flank pain, vomiting, and elevated blood pressure. A computed tomography scan of the abdomen and pelvis confirmed the presence of a perinephric hematoma, and the interventional radiology team was consulted to resolve the Page kidney. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptoms seen in Page kidney may be similar to other more common diagnoses encountered in the emergency department. It is important to maintain a high suspicion and order imaging studies as needed, especially in the setting of trauma, or a recent procedure in the vicinity of the renal parenchyma.

Autosomal dominant polycystic kidney disease with ectopic unilateral multicystic kidney: a case report.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disorder and the fourth cause of death of end-stage renal disease. The disease has a prevalence of 1:400-1:1000 accounting for 10% of patients on dialysis. In most ADPKD patients, bilateral kidneys are similarly affected, with numerous fluid-filled cysts arising from different nephron segments. Only a few cases of ADPKD with ectopic unilateral multicystic kidney have been reported. It has been observed that the deterioration of their kidney function seemed to be quicker than their age- and sex-matched controls and siblings especially when the ectopic kidney is dysplastic. CASE PRESENTATION: We report a case of a 46-year-old Ghanaian male patient who presented with left flank pain and hematuria with high BP and deranged renal function. Abdominal ultrasonography showed both kidneys to be larger than normal and had multiple cysts of varying sizes with the right kidney located in the right iliac fossa. Follow up Abdominopelvic computer tomographic scan (CT-Scan) without contrast showed enlarged kidneys with the renal parenchyma replaced by innumerable cyst of varying sizes. The right kidney was ectopically located in the right aspect of the pelvis. A diagnosis of ADPKD with right pelvic ectopic multicystic kidney was made. He was put on antihypertensives, analgesia for the left flank pain and to have follow up at the urology and nephrology departments. CONCLUSION: In most ADPKD patients, bilateral kidneys are similarly affected. Only a few cases of ADPKD with ectopic unilateral multicystic kidney have been reported. It has been observed that the deterioration of their kidney function seemed to be quicker than their age- and sex-matched controls and siblings especially when the ectopic kidney is dysplastic.

Hernia diafragmática postraumática / Post-traumatic diaphragmatic hernia

No disponible

Síndrome de Fitz-Hugh-Curtis como causa de dolor agudo en hipocondrio derecho en paciente en edad fértil / Fitz-Hugh-Curtis's syndrome because of intense pain in the right hypochondrium in patient in fertile age

Introducción: el síndrome de Fitz-Hugh-Curtis consiste en una perihepatitis, secundaria a una enfermedad inflamatoria pélvica, que puede debutar como dolor agudo en hipocondrio derecho sin acompañarse de la sintomatología clásica de dolor en hipogastrio, dispareunia y leucorrea maloliente. Caso clínico: en este artículo presentamos el caso de una mujer de 18 años que debutó con un dolor agudo en hipocondrio derecho como consecuencia de un Sd. Fitz-Hugh-Curtis y a propósito del caso hacemos una revisión de la literatura existente. Discusión: esta inusual presentación de la enfermedad inflamatoria pélvica hace que todavía continúe siendo un proceso infradiagnosticado, pero que es necesario tener en cuenta al realizar el diagnóstico diferencial de un dolor agudo en hipocondrio derecho en una paciente en edad fértil, ya que en la mayoría de casos la sintomatología mejora con el tratamiento antibiótico, por lo que el pronóstico es muy favorable

Introduction: Fitz-Hugh-Curtis's syndrome consists of a secondary perihepatitis to an inflammatory pelvic disease that can begin with an intense pain in right hypochondrium without being accompanied by the classic symptomatology of pain in hypogastrium, dispareunia and malodorous leucorrea. Clinical Case: In this article, it is presented the case of an 18 years old woman who begins with an intense pain in right hypochondrium as a consequence of a Fitz-Hugh-Curtis's syndrome and regarding the case, we do a review of the current literature. Discussion: This unusual presentation of the inflammatory pelvic disease makes that it still continues being a infradiagnosed process, but which is necessary to keep in mind when we carry out the differential diagnosis of an intense pain in the right hypochondrium in a patient in fertile age, since in the majority of cases, the symptomatology improves with the antibiotic treatment, for what the prognosis is very favorable

Foramen oval permeable con anticardiolipina+, una causa rara de infartos renales múltiples / Patent foramen ovale and anticardiolipin antibodies, a strange cause of bilateral kidney infarcion

No disponible

The burden of chronic ureteral stenting in cervical cancer survivors

ABSTRACT Purpose Ureteral obstruction in cervical cancer occurs in up to 11% of patients, many of whom undergo ureteral stenting. Our aim was to describe the patient burden of chronic ureteral stenting in a population-based cohort by detailing two objectives: (1) the frequency of repeat procedures for ureteral obstruction; and, (2) the frequency of urinary adverse effects (UAEs) (e.g., lower urinary tract symptoms, flank pain). Materials and Methods From SEER-Medicare, we identified 202 women who underwent ureteral stent placement prior to or following cervical cancer treatment. The frequency of repeat procedures and rate ratios were compared between treatment modalities. The rates and rate ratios of UAEs were compared between our primary cohort (stent + cervical cancer) and the following groups: no stent + cervical cancer, stent + no cancer, and no stent + no cancer. The “no cancer” group was drawn from the 5% Medicare sample. Results 117/202 women (58%) underwent >1 stent procedure. The frequency of additional procedures was significantly higher in patients who received radiation as part of their treatment. UAEs were very common in women with stent + cancer. The rate of UTI was 190 (per 100 person-years), 67 for LUTS, 42 for stones, and 6 for flank pain. These rates were 3-10 fold higher than in the no stent + no cancer control group; rates were also higher than in the no stent + cancer and the stent + no cancer women. Conclusions The burden of disease associated with ureteral stents is higher than expected and urologists should be actively involved in stent management, screening for associated symptoms and offering definitive reconstruction when appropriate.

Dolor abdominal por extrusión discal dorsal / Abdominal pain due to thoracic disc herniation

No disponible

Dorsalgia crónica que resultó ser Espondilodiscitis tuberculosa / Chronic dorsalgia that was found to be Pott's disease

No disponible

Infarto renal derecho. Presentación de un nuevo caso / Right renal infarction: a new case report

OBJETIVO: Presentar un nuevo caso de infarto renal. MÉTODOS: Se presenta el caso de una mujer de 84 años con dolor cólico en flanco derecho de 24 horas de evolución y con antecedente de infarto agudo de miocardio cuatro meses antes. CONCLUSIÓN: El infarto renal es una patología rara, dando lugar en la mayoría de los casos a una sintomatología inespecífica y solapable a otros procesos urológicos más frecuentes, lo que implica un retraso en su diagnóstico y en su tratamiento. Las pruebas de imagen más concluyentes son la Tc con contraste o la Eco-Doppler pero el diagnóstico de certeza es por angiografía o angio-Tc. Su tratamiento es conservador, anticoagulación parenteral y oral, el manejo invasivo es infrecuente (AU)

OBJECTIVE: To present a new case of renal infarction. METHODS: We report the case of an 84-year-old woman presenting with right flank colic pain of 24 hours of evolution and past history of acute myocardial infarction four months before. CONCLUSION: Renal infarction is a rare condition; in most of the cases it does not show specific symptoms and usually overlap with other more common urologic procedures, which results in a delay in diagnosis and treatment. The most conclusive imaging tests are i.v contrast CT scan or Doppler ultrasound but definitive diagnosis is achieved by angiography or CT angiography. Treatment is conservative, with parenteral and oral anticoagulation; invasive management is rare (AU)

Embolización de aneurisma calcificado de arteria renal en paciente monorreno / Calcified renal artery aneurism embolization in a solitary kidney

OBJETIVO: Revisar la presentación, diagnóstico y tratamiento de una entidad poco frecuente como los aneurismas de la arteria renal.MÉTODOS: Presentamos el caso de un paciente monorreno con un aneurisma renal calcificado sintomático.RESULTADOS: Los aneurismas de la arteria renal pueden provocar hipertensión, hematuria, dolor en flanco, o ser totalmente asintomáticos. Las causas más frecuentes son laarteriosclerosis y la displasia fibromuscular y el diagnóstico se basa en la tomografía computerizada y en la angiografía. El tratamiento puede ser quirúrgico, endovascular o expectante.CONCLUSIONES: Los aneurismas de la arteria renal son una patología sobre la que, por su baja prevalencia, no existen pautas claras de actuación. El número de casos diagnosticados ha aumentado en las últimas décadas y el tratamiento endovascular se muestra como una buena opción(AU)

OBJECTIVE: To review presentation, diagnosis and treatment of renal artery aneurysms, a very uncommon disease.METHODS: We report the case of a male with a calcified renal artery aneurysm in a solitary kidney.RESULTS: Symptomatic effects may be hypertension, hematuria or flank pain. Arteriosclerosis and medial dysplasia are the most frequent causes and diagnosis is based on CT scan and angiography.CONCLUSIONS: The renal artery aneurysm is a disease with low prevalence and there is no clear protocol for management. The number of cases has increased over the last decades and endovasculrar treatment is a good therapeutic option(AU)

Masa anexial derecha con diagnóstico intraoperatorio de mucocele apendicular. A propósito de un caso / Right adnexal mass with intraoperative diagnosis of appendiceal Mucocele. A case report

El mucocele apendicular es una patología infrecuente y de difícil diagnóstico. Se presenta el caso de una paciente de 48 años con historia de dolor en fosa ilíaca derecha (FID), intervenida por un diagnóstico de sospecha de cistadenoma de ovario derecho, con diagnóstico intraoperatorio de mucocele apendicular (AU)

Appendiceal mucocele is a rare lesion that is difficult to diagnose. We report thecase of a 48-year-old woman with a history of right iliac fossa pain, who underwent surgerydue to a suspected diagnosis of right ovarian cystadenoma. The intraoperative diagnosis was appendiceal mucocele (AU)