Differential Diagnosis for Flank Pain and CVA Tenderness
Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stones): This condition is a common cause of flank pain and costovertebral angle (CVA) tenderness due to the obstruction of the urinary tract by a stone, leading to pain and inflammation.
Other Likely Diagnoses
- Pyelonephritis: An infection of the kidney, which can cause flank pain and CVA tenderness due to inflammation of the kidney tissue.
- Musculoskeletal Strain: Strain or injury to the muscles in the flank area can cause pain and tenderness, including CVA tenderness if the strain involves the muscles attached to the ribs or vertebrae.
Do Not Miss Diagnoses
- Renal Infarction: A condition where the blood supply to the kidney is interrupted, leading to tissue death. It presents with severe flank pain and can have CVA tenderness, and is critical to diagnose early for potential intervention.
- AAA (Abdominal Aortic Aneurysm): Although AAA typically presents with abdominal pain, it can radiate to the flank and, in rare cases, cause CVA tenderness if it involves or compresses nearby structures. Early diagnosis is crucial due to the high risk of rupture.
- Sepsis from a Urinary Tract Infection: While not exclusively causing flank pain and CVA tenderness, sepsis from a urinary tract infection can present with these symptoms and is life-threatening if not promptly treated.
Rare Diagnoses
- Papillary Necrosis: A condition where part of the kidney (renal papillae) dies due to lack of blood flow, often associated with diabetes or analgesic abuse. It can cause flank pain and may have CVA tenderness.
- Renal Cell Carcinoma: A type of kidney cancer that can cause flank pain and, less commonly, CVA tenderness if the tumor grows large enough to press on surrounding structures.
- Retroperitoneal Fibrosis: A rare condition characterized by the proliferation of fibrous tissue in the retroperitoneum, which can encase and obstruct structures like the ureters, leading to flank pain and potentially CVA tenderness.