DÄ internationalArchive41/2016Clinical snapshot Left Flank Pain in a 73-Year-Old Man

Clinical Snapshot

Clinical snapshot Left Flank Pain in a 73-Year-Old Man

Dtsch Arztebl Int 2016; 113(41): 691; DOI: 10.3238/arztebl.2016.0691

LNSLNS

A 73-year-old man presented to the emergency room one evening complaining of left flank pain radiating into the left groin for the past three days. His self-reported prior medical history included arterial hypertension and cigarette smoking. The physical findings were normal except for pain on percussion of the left flank. Routine laboratory studies and a urinalysis were normal. Abdominal ultrasonography, performed at the bedside by a relatively inexperienced examiner, was uninformative, also because of the patient’s obesity and meteorism. An abdominal plain film in the upright position yielded no evidence of a perforated hollow viscus. Symptomatic treatment was given; the pain did not respond to opioids. Abdominal computerized tomography the next morning revealed a covered perforation of an infrarenal abdominal aortic aneurysm (AAA), and the patient was taken to surgery at once. Ruptured AAAs usually become symptomatic with back pain or abdominal pain, and only rarely with pain in the flank and/or groin. Renal colic is the most common misdiagnosis of previously undiagnosed AAA. The differential diagnosis of flank and groin pain should include AAA in any patient with risk factors for AAA, particularly if the pain does not respond to symptomatic treatment.

Covered perforation of an infrarenal abdominal aortic aneurysm (arrowhead)
Covered perforation of an infrarenal abdominal aortic aneurysm (arrowhead)
Figure
Covered perforation of an infrarenal abdominal aortic aneurysm (arrowhead)

Conflict of interest statement
The authors declare that no conflict of interest exists.

Dr. med. Peter Korsten Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, peter.korsten@med.uni-goettingen.de

Prof. Dr. med. Sabine Blaschke Interdisziplinäre Notaufnahme, Universitätsmedizin Göttingen, Göttingen

Cite this as: Korsten P, Blaschke S: Left Flank Pain in a 73-Year-Old Man. Dtsch Arztebl Int 2016; 113: 691. DOI: 10.3238/arztebl.2016.0691

Translated from the original German by Ethan Taub, M.D.

Covered perforation of an infrarenal abdominal aortic aneurysm (arrowhead)
Covered perforation of an infrarenal abdominal aortic aneurysm (arrowhead)
Figure
Covered perforation of an infrarenal abdominal aortic aneurysm (arrowhead)