A 55-Year-Old Man With Recurrent Sharp Flank Pain

Jyoti Wadhwa, MBBS, MD; Madhavi Tripathi, MBBS, MD; Madhur Kumar Srivastava, MBBS

Disclosures

September 14, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 55-year-old man presents to the emergency department with recurrent pain in his right flank. The pain is described as sharp, severe in intensity, and radiating to the groin. Additionally, it increases with urination. He also gives a history of blood-tinged urine that occurred 1 day before the onset of the pain.

He denies having any history of fever, vomiting, or dysuria; however, he does report experiencing two similar episodes in the past year, both of which were relieved with oral analgesics. He denies having any bone pain, generalized weakness, change in bowel habits, or history of seizures. No history of similar episodes among his family members is reported.

The patient is a nonsmoker and denies heavy alcohol use. He has no known history of chronic medical or psychiatric conditions and is not taking any regular medications.

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