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Challenges in managing a patient with multiple primary malignancies
An 81-year-old African American man presented to the emergency department with right flank pain for 3 days. He had first noticed the pain after lifting a heavy box. He described the pain as sharp, nonradiating, and worsening with movement. He denied nausea, vomiting, diarrhea, fever, chills, cough, abdominal or back pain, dysuria, hematuria, or increased urinary frequency. The differential diagnosis for flank pain is broad. In this case, the pain started after lifting a heavy box, suggestive of musculoskeletal etiology such as muscle strain or rib fracture. Although less likely, both nephrolithiasis with passage of a stone and pyelonephritis must be ruled out. Other genitourinary pathologic processes to be considered would include renal infarct or hemorrhage, ureteral obstruction, and malignancy. The pain may also be of hepatic or biliary origin. Diverticulitis and colitis need to be considered. Finally, the pain may be referred from a pulmonary process such as right lower lobe pneumonia. Further history and a thorough physical exam are needed to narrow down these possibilities...
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An 81-year-old African American man presented to the emergency department with right flank pain for 3 days. He had first noticed the pain after lifting a heavy box. He described the pain as sharp, nonradiating, and worsening with movement. He denied nausea, vomiting, diarrhea, fever, chills, cough, abdominal or back pain, dysuria, hematuria, or increased urinary frequency. The differential diagnosis for flank pain is broad. In this case, the pain started after lifting a heavy box, suggestive of musculoskeletal etiology such as muscle strain or rib fracture. Although less likely, both nephrolithiasis with passage of a stone and pyelonephritis must be ruled out. Other genitourinary pathologic processes to be considered would include renal infarct or hemorrhage, ureteral obstruction, and malignancy. The pain may also be of hepatic or biliary origin. Diverticulitis and colitis need to be considered. Finally, the pain may be referred from a pulmonary process such as right lower lobe pneumonia. Further history and a thorough physical exam are needed to narrow down these possibilities...
Click on the PDF icon at the top of this introduction to read the full article.
An 81-year-old African American man presented to the emergency department with right flank pain for 3 days. He had first noticed the pain after lifting a heavy box. He described the pain as sharp, nonradiating, and worsening with movement. He denied nausea, vomiting, diarrhea, fever, chills, cough, abdominal or back pain, dysuria, hematuria, or increased urinary frequency. The differential diagnosis for flank pain is broad. In this case, the pain started after lifting a heavy box, suggestive of musculoskeletal etiology such as muscle strain or rib fracture. Although less likely, both nephrolithiasis with passage of a stone and pyelonephritis must be ruled out. Other genitourinary pathologic processes to be considered would include renal infarct or hemorrhage, ureteral obstruction, and malignancy. The pain may also be of hepatic or biliary origin. Diverticulitis and colitis need to be considered. Finally, the pain may be referred from a pulmonary process such as right lower lobe pneumonia. Further history and a thorough physical exam are needed to narrow down these possibilities...
Click on the PDF icon at the top of this introduction to read the full article.