clinical snapshot - Deutsches Ärzteblatt

MEDICINE
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On behalf of the authors:
Prof. Dr. med. Klaus J. Neis
Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin der Universitätskliniken des Saarlandes
Homburg
[email protected]
Conflict of interest statement
Prof. Neis is the scientific director of an endoscopic training center (ETC) for
operative, in particular endoscopic, surgery supported by the companies Storz
and Erbe
CLINICAL SNAPSHOT
Left Flank Pain in a 73-Year-Old Man
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 Covered perforation of an infrarenal abdominal aortic aneurysm
symptomatic with back pain or abdominal pain, and (arrowhead)
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.
Conflict of interest statement
The authors declare that no conflict of interest exists.
Dr. med. Peter Korsten Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, [email protected]
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.
Deutsches Ärzteblatt International | Dtsch Arztebl Int 2016; 113
691

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