Skill Checkup: A 66-Year-Old Man With Back Pain and Palpable Mass on Left Flank

Elwyn C. Cabebe, MD


August 16, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 66-year-old Black man in the United States with hypertension indicates that he has been having pain in his back, which he thought was a pulled muscle. However, he claims that the pain hasn't changed even with the use of massage and a heating pad. He also states that he has been running occasional fevers but had no other signs of infection.

His body mass index is 40 kg/m2. Physical examination identified a palpable mass on his left flank and the presence of scrotal varicocele. Laboratory results include microscopic hematuria, anemia, and hypercalcemia. His hemoglobin level is 11 g/dL, neutrophil count is 8.5 x109/L, and platelet count is 350,000/µL.

CT shows a single solid mass in his kidney.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.