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CT abnormality/Flank Pain

Posted by Sandra on April 24, 1999 at 07:28:34
A few months ago I had a CT scan of my kidneys during a repeat episode of moderate to severe right sided flank pain.  The CT showed what I was told looked like a small area of scarring or calcification on the outer surface of my kidney.  I have had at least one kidney infection in the past and it was thought this could be a remnant.  Both kidney disease and kidney stones run in my family; however, no evidence of stones was seen.  A orthopedic surgeon I consulted did not feel the pain was musculoskeletal in origin.  The pain gradually lessened over the next three months and finally went away. It didn't stay away very long though and has come back gradually worsening again to a moderate level, occasionally severe.  Breathing is occasionally painful, it's impossible to get into a comfortable position though splinting that side does seem to help a little, the pain is constant and dull (occasionally knife-like)and never moves from the one spot over my right kidney directly over the area the CT abnormality was indicated (though when it gets severe it does radiate to my right shoulder and down around my lower right side).  
Twice in the past I've had right flank pain severe enough to require hospitalization.  These episodes plus a few others were associated with fevers, shaking chills, nausea/vomiting and severe pain.  I've been told that these episodes were probably kidney stones though no workup for stones was done at the time.
I've had some trouble getting any consults for this problem primarily due to the fact that we're military and never see the same PCP twice in our system so no single person has a good sense of my history.  Therefore, could you please tell me if a nephrology consult is indicated and if the finding on the CT scan could possibly have any relevance to the pain I've been experiencing?  I, of course, realize you can't give a diagnosis based on this sketchy information...I just want to know what the possibilities are.  

Posted by HFHS M.D.-BE on April 25, 1999 at 22:09:04

Dear Sandra,
A CT scan, preferably a "spiral CT" is the study of choice for imaging kidney stones at many centers.  It appears that the CT scan that was performed did not show stones.  Occasionally stones may be too small to be picked up by the scan, yet could be responsible for symptoms.  The history you have given could potentially be due to kidney stones, especially since you say you have a family history of kidney problems.  However, a right-sided pain, including the radiating pain up the side and into the arm, as you have described, could possibly be due to gallbladder disease, inflammation, or stones.  This condition could be seen on CT scan, if a normal abdominal CT was done.  The calcification seen on the outside of the kidney is unlikely to be causing such unremitting pain, and  may be a result of previous condition(s) such as kidney infection.  Kidney cancers can also have calcifications and must be ruled out. I would suggest that you see a urologist right away.  If necessary, the urologist will refer you to a nephrologist.  It is, I am certain, frustrating for you not to be able to see the same physician to follow your history and progression of symptoms.  You say that you were hospitalized with rather serious symptoms but no workup was done, just a supposition of cause.  At this point, you really do need a thorough workup.  A urologist will be able to do a full evaluation, and order any tests and imaging studies that may be helpful in making the diagnosis.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
*keyword: flank pain

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