Possible Causes for costovertebral angle tenderness Acute Cystitis A high overestimation error was associated with the symptoms of urinary frequency or suprapubic tenderness and costovertebral angle tenderness on examination. [ncbi.nlm.nih.gov] If the patient has fever, chills, and severe costovertebral angle tenderness the possibility of acute pyelonephritis should be excluded. [lecturio.com] angle tenderness in addition to urinary symptoms. 4 Diagnosis Urine samples obtained through the midstream clean-catch technique can be used to provide more conclusive evidence [uspharmacist.com] Acute Pyelonephritis Costovertebral angle tenderness Medical diagnostics The costovertebral angle is located in the back between the 12th rib and the spine Purpose test in which pain is elicited [en.wikipedia.org] She has costovertebral angle tenderness. [mdedge.com] Common signs and symptoms include acute-onset fever, chills, severe back or flank pain, nausea and vomiting, and costovertebral angle tenderness. [bestpractice.bmj.com] Pyelonephritis Costovertebral angle tenderness The costovertebral angle is located in the back between the 12th rib and the spine Purpose test in which pain is elicited by percussion Costovertebral [en.wikipedia.org] angle tenderness may be present. o CBC § Elevated white blood cell count. o Urinalysis § Bacteriuria § Pyuria § White blood cell casts o Acute pyelonephritis is clinical [learningradiology.com] Common signs and symptoms include acute-onset fever, chills, severe back or flank pain, nausea and vomiting, and costovertebral angle tenderness. [bestpractice.bmj.com] Urinary Tract Infection On physical examination, there was costovertebral angle tenderness and her urinalysis was indicative for urinary tract infection. [ncbi.nlm.nih.gov] Because of the referred pain pathways, even simple lower UTI may be accompanied by flank pain and costovertebral angle tenderness. [emedicine.medscape.com] Flank pain and costovertebral angle tenderness (may be present in cystitis but suggest upper UTI) Bloody urine Fevers, chills, and malaise (may be noted in patients with [emedicine.medscape.com] Hemophilia Fetal Pediatr Pathol. 2015;34(4):248-51. doi: 10.3109/15513815.2015.1051250. Epub 2015 Jun 24. Author information 1 Clinic for Ginecology and Obstretics, Clinical Centre of Serbia, Department Neonatology, Belgrade, Serbia. Abstract Hemophilia is the most common inherited coagulation disorder, and approximately one-half of[…] [ncbi.nlm.nih.gov] Herpes Simplex Infection The acquisition of genital herpes during pregnancy has been associated with spontaneous abortion, prematurity, and congenital and neonatal herpes. The frequency of seroconversion, maternal symptoms of the disease, and the timing of its greatest effect on the outcome of pregnancy have not been systematically[…] [ncbi.nlm.nih.gov] Hemophilia A and peritoneal signs Genitourinary - Bladder spasm/distension/pain and costovertebral angle pain Other - Hematoma leading to location-specific signs (eg, airway obstruction [emedicine.medscape.com] […] warmth Central nervous system (CNS) - Abnormal neurologic exam findings, altered mental status, and meningismus Gastrointestinal (GI) - Can be painless; hepatic/splenic tenderness [emedicine.medscape.com] Hemophilia B […] and peritoneal signs GU - Bladder spasm/distension/pain, costovertebral angle pain Other - Hematoma leading to location-specific signs (eg, airway obstruction, compartment [emedicine.medscape.com] […] and peritoneal signs Genitourinary: Bladder spasm/distention/pain, costovertebral angle pain Other: Hematoma leading to location-specific signs (eg, airway obstruction, compartment [emedicine.medscape.com] […] decreased range of motion, swelling, effusion, and warmth CNS - Abnormal neurologic exam findings, altered mental status, and meningismus GI - Can be painless; hepatic/splenic tenderness [emedicine.medscape.com] Medullary Sponge Kidney These include costovertebral angle tenderness and ipsilateral groin, which usually underline the presence of nephrolithiasis, and fever, tachycardia, and hypotension, suggestive [symptoma.com] Acute Otitis Externa She has costovertebral angle tenderness. [mdedge.com] Costovertebral angle tenderness is commonly unilateral over the affected kidney, but in some cases, bilateral costovertebral angle tenderness may be present. [ncbi.nlm.nih.gov] angle tenderness on physical examination and leukocytosis, pyuria, and bacteriuria on laboratory studies. [mdedge.com] Urolithiasis Department of Physiology, Keimyung University School of Medicine, Daegu, Korea. dksong@kmu.ac.kr Abstract Urolithiasis is suspected by flank pain, costovertebral angle tenderness [koreamed.org] A history of fever or dysuria and costovertebral angle tenderness on physical examination were inversely associated with urolithiasis on UCT scans. [pediatrics.aappublications.org] angle tenderness & lower extremity edema, as well as signs of primary hyperparathyroidism (HPT) & gout in the assessment Laboratory Tests Serum chemistries should include [specialty.mims.com] Renal Colic Abdominal assessment is unremarkable, but you note costovertebral angle tenderness. What's your assessment? Based on Mr. [journals.lww.com] Both diagnoses may present with flank pain, costovertebral angle tenderness, nausea, and vomiting. [emdocs.net] Costovertebral angle tenderness is a common finding as well [ 2 ]. [bmcurol.biomedcentral.com] Chronic Pyelonephritis angle tenderness Presence of fever may indicate prostatitis or pyelonephritis All cases of pyelonephritis or perinephric abscess need urologic evaluation. [lecturio.com] Patients typically present with flank pain, costovertebral angle tenderness, fever, and other features of cystitis (e.g., dysuria, frequency). [amboss.com] Costovertebral angle tenderness is commonly unilateral over the affected kidney, but in some cases, bilateral costovertebral angle tenderness may be present. [ncbi.nlm.nih.gov] Cystitis Findings such as flank pain, costovertebral angle tenderness, nausea, and vomiting are also more indicative of upper UTI or pyelonephritis. [ncbi.nlm.nih.gov] Flank pain and costovertebral angle tenderness (may be present in cystitis but suggest upper UTI) Bloody urine Fevers, chills, and malaise (may be noted in patients with [emedicine.medscape.com] Fever and costovertebral angle tenderness suggest pyelonephritis. [infectiousdiseaseadvisor.com] Hyperuricemia Nephrolithiasis has no specific physical exam findings but may have costovertebral angle tenderness. Look for hematuria on urinalysis. [ncbi.nlm.nih.gov] Trichomonas Cystitis […] have gross hematuria Risk factors present (see Table 5 ) May have suprapubic tenderness; no costovertebral angle tenderness Usually positive for pyuria and sometimes also [aafp.org] For cystitis: Check for presence of suprapubic or lower abdominal tenderness, no costovertebral angle tenderness, no epididymal tenderness or prostatic tenderness on exam. [cancertherapyadvisor.com] Fever (greater than 38.5 C [101.3 F]), costovertebral angle tenderness or upper abdominal tenderness to deep palpation suggest acute pyelonephritis. [aafp.org] Periurethral Abscess No costovertebral angle tenderness was observed. [journals.lww.com] A history of urethral discharge was not observed, and digital rectal examination showed a tenderness pattern with a burning sensation in the prostate. [journals.lww.com] Puerperal Pelvic Cellulitis The first sign of renal infection may be fever, followed later by costovertebral angle tenderness, nausea, and vomiting. [accessmedicine.mhmedical.com] Costovertebral angle tenderness and other clinical signs of acute pyelonephritis are not usually present. [glowm.com] Nephrolithiasis Physical examination is significant for left-sided costovertebral angle tenderness. Urine dipstick is heme positive. Urinalysis also shows envelope-shaped crystals. [medbullets.com] angle) tenderness Microscopic hematuria Diagnostic tests CBC with differential Serum calcium, phosphorus, uric acid and creatine Urinalysis Urine culture and sensitivity [cancertherapyadvisor.com] […] on percussion (costovertebral angle tenderness) Hematuria Nausea, vomiting, and reduced bowel sounds Dysuria, frequency, and urgency Passage of gravel or a stone Depending [amboss.com] Staghorn Calculus angle tenderness 10. [slideshare.net] Physical Examination Examination reveals the absence of costovertebral angle tenderness. Evaluation Her serum creatinine level is 1.7 mg/dL. [ncbi.nlm.nih.gov] Examination • a chronically ill-appearing patient • Body habitus, • presence of vertebral kyphoscoliosis • In acute pyelonephritis or pyonephrosis - 1. toxic appearance 2. costovertebral [slideshare.net] Lower Urinary Tract Infection angle tenderness (which would suggest an upper urinary tract infection.) [ncemi.org] Differential Diagnosis of Recurrent Dysuria Diagnosis Associated features Acute pyelonephritis Nausea, fever, flank pain, costovertebral angle tenderness, pyuria with casts [aafp.org] Flank pain and costovertebral angle tenderness (may be present in cystitis but suggest upper UTI) Bloody urine Fevers, chills, and malaise (may be noted in patients with [emedicine.medscape.com] Supernumerary Kidney She also displayed significant costovertebral angle tenderness and moderate pain on palpation along the posterior superior iliac spine. [shmabstracts.com] On arrival, she was febrile at 38.6 C and tachycardic to 95 bpm, with diffuse tenderness bilaterally in her upper and lower extremities. [shmabstracts.com] Perinephric Abscess 05:49 They may also feel suprapubic heaviness or pain. 05:54 But testing for costovertebral angle tenderness is extremely important. 06:01 Men will very often have fever [lecturio.com] A physical examination revealed right upper quadrant tenderness and right costovertebral angle tenderness. [synapse.koreamed.org] A physical examination revealed bilateral costovertebral angle tenderness. [bmcresnotes.biomedcentral.com] Ureterolithiasis There is tenderness to the left lower quadrant. There is no guarding or rebound and no costovertebral angle tenderness. [emra.org] Examination in patients with nephrolithiasis includes the following findings: • Dramatic costovertebral angle tenderness; pain can move to upper/lower abdominal quadrant with [scribd.com] The abdomen may be somewhat tender on the affected side as palpation increases pressure in the already-distended kidney (costovertebral angle tenderness), but peritoneal signs [msdmanuals.com] Upper Urinary Tract Infection Differential Diagnosis of Recurrent Dysuria Diagnosis Associated features Acute pyelonephritis Nausea, fever, flank pain, costovertebral angle tenderness, pyuria with casts [aafp.org] angle tenderness acute haematuria 31. [slideshare.net] Flank pain (may radiate to groin, often dull and constant) Costovertebral angle (CVA) tenderness Sudden renal edema, resulting in increased pressure and capsular distension [pathophys.org] Puerperal Infection Angle Tenderness 1161 Checking for Deep Tendon Reflexes and Clonus 1163 Pelvic Examination 1169 Obtaining a Specimen for Papanicolaou Pap Diagnostic Evaluation 1195 Obtaining [books.google.de] Catheter 1121 Giving Intravenous Medications 1125 SpinDown Hematocrit 1127 Removal of Norplant 1131 Breast Examination 1135 Obstetric Abdominal Examination 1147 Checking for Costovertebral [books.google.de] Renal Abscess Costovertebral angle tenderness is almost uniformly present with each type of corticomedullary infection. [emedicine.medscape.com] Physical examination identified costovertebral angle tenderness and pedal edema. An ultrasound scan revealed a mass in his left kidney. [jmedicalcasereports.biomedcentral.com] Acute pyelonephritis • Symptoms Flank pain, costovertebral angle tenderness Fever, chills, nausea, & vomiting Lower symptoms: dysuria, frequency, urgency • Laboratory Neutrophilic [slideshare.net] Renal Infarction Physical examination was unremarkable except right costovertebral angle tenderness. His labs showed creatinine 0.9 mg/dl, GFR above 60 and INR 1.8. [shmabstracts.com] Vital findings were normal in the physical examination except left costovertebral angle tenderness. [omicsonline.org] On presentation, he was tachycardic, febrile and had severe right costovertebral angle tenderness. [bmcnephrol.biomedcentral.com] Renal Teratoma [19] Right kidney 35 years Female Right flank pain, right costovertebral angle tenderness, no carcinoid syndrome CT: Exophytic, round, well-circumscribed mildly complex [ncbi.nlm.nih.gov] [ 19 ] Right kidney 35 years Female Right flank pain, right costovertebral angle tenderness, no carcinoid syndrome CT: Exophytic, round, well-circumscribed mildly complex [diagnosticpathology.biomedcentral.com] Urethritis For cystitis: Check for presence of suprapubic or lower abdominal tenderness, no costovertebral angle tenderness, no epididymal tenderness or prostatic tenderness on exam. [clinicaladvisor.com] For urethritis: Check for penile discharge, meatal crusts, no costovertebral angle tenderness, no epididymal tenderness or prostatic tenderness on exam. [clinicaladvisor.com] The presence of costovertebral angle tenderness and/or fever may indicate upper urinary tract involvement. The presence of urinary discharge may indicate urethritis. [clinicaladvisor.com]
