Skip to main content

Acute left flank pain

Bedside ultrasound is becoming a very important tool in emergency medicine. One of the staples of bedside ultrasound is its potential in assisting the clinician with information on local anatomy and organ function.

A previously healthy 44-year-old male presented to the emergency department with acute dysuria and left flank pain. A renal bedside ultrasound was obtained and showed excellent urine flow into the bladder from bilateral duplicated ureters (Fig. 1) and no hydronephrosis. An acute ureteral obstruction was therefore excluded.

Fig. 1
figure1

Bladder ultrasound using power Doppler and B-mode: the still image shows a strong ureteral flow into the bladder from the left duplicated ureteral os

The patient was subsequently diagnosed with a urinary tract infection in the setting of duplex collecting system. No renal calculus was detected on computed tomography.

He received antibiotic and fluid hydration management in the emergency department and was discharged with close outpatient urology follow-up.

Complete ureteral duplication is a rare condition occurring in about 0.2–0.8% of the population [13] and is often detected incidentally. A symptomatic patient can present with findings such as ureteropelvic junction obstruction, vesicoureteric reflux, or urinary tract infection resulting in parenchymal scarring [13]. Patients with this diagnosis require close urology follow-up for thorough renal and collecting system assessment. Therapeutic or prophylactic surgical intervention and prophylactic treatment with antibiotics might be indicated to prevent renal dysfunction [15].

References

  1. 1.

    Fernbach SK, Feinstein KA, Spencer K, Lindstrom CA (1997) Ureteral duplication and its complications. Radiographics 17(1):109–127

    PubMed  CAS  Article  Google Scholar 

  2. 2.

    Schlussel RN, Retik AB (2002) Ectopic ureter, ureterocele, and other anomalies of the ureter. In: Walsh PC (ed) Campbell’s urology. Saunders, Philadelphia, pp 2007–2052

    Google Scholar 

  3. 3.

    Chacko JK, Koyle MA, Mingin GC, Furness PD 3rd (2007) Ipsilateral ureteroureterostomy in the surgical management of the severely dilated ureter in ureteral duplication. J Urol 178(4 Pt 2):1689–1692

    PubMed  Article  Google Scholar 

  4. 4.

    Afshar K, Papanikolaou F, Malek R, Bagli D, Pippi-Salle JL, Khoury A (2005) Vesicoureteral reflux and complete ureteral duplication. Conservative or surgical management? J Urol 173(5):1725–1727

    PubMed  Article  Google Scholar 

  5. 5.

    Hensle TW, Hyun G, Grogg AL, Eaddy M (2007) Part 2: Examining pediatric vesicoureteral reflux: a real-world evaluation of treatment patterns and outcomes. Curr Med Res Opin 23(Suppl 4):S7–S13

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Beatrice Hoffmann.

Rights and permissions

Open Access This is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License ( https://creativecommons.org/licenses/by-nc/2.0 ), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Reprints and Permissions

About this article

Cite this article

Hoffmann, B. Acute left flank pain. Int J Emerg Med 2, 131 (2009). https://doi.org/10.1007/s12245-009-0110-2

Download citation

Keywords

  • Emergency Department
  • Urinary Tract Infection
  • Hydronephrosis
  • Vesicoureteric Reflux
  • Flank Pain