History of Present Illness:

A patient in their mid-40’s with no known PMH presents to the hospital with 2 days of left flank pain and urinary frequency.  He denies hematuria, fever, vomiting or any other complaints.

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is also normal except for left CVA tenderness

Initial Diagnostic Testing:

  • CBC and CRP: normal
  • Chem-7 and UA: normal
  • Imaging: Renal US shows a 2cm L renal cyst, CT contrast shown below

What is the most likely diagnosis?

  • A) Renal cyst
  • B) Renal stone
  • C) Renal infarct
  • D) Renal abscess

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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QUIZ ANSWER:

  • A) Renal cyst
  • B) Renal stone
  • C) Renal infarct – CORRECT – it is the darker area of the kidney that is not contrast enhanced
  • D) Renal abscess

1-Minute Consult on this topic: Click HERE and scroll to page 338.

 

CASE CONCLUSION: Admitted, LDH & D-dimer normal, UA normal except for small protein.  Echo showed a dilated RV on preliminary report.  Bubble study was not done

CASE LESSONS: When imaging shows a finding that should not be painful (L renal cyst in this case) it is likely a red herring and so you should continue to look for the actual cause if indicated.  Although LDH and D-dimer often elevated with renal infarct, this is not always the case.

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