All pain and no gain: Renal stones

Case presentation

An 11-year-old male presents with acute onset of left-sided lower abdominal pain and left-sided flank pain, which began 1–2 hours prior to presentation. The patient was not engaged in any particular activity; he states that he was “just relaxing” when the pain began. He denies trauma. There has been no fever, back pain, dysuria, hematuria, testicular pain/swelling, or other abdominal pain. While he has not had vomiting, he does report nausea.

The patient appears uncomfortable on physical examination but is not toxic. His vital signs show a temperature of 98 degrees Fahrenheit, a heart rate of 100 beats per minute, a respiratory rate of 22 breaths per minute, a blood pressure of 108/58 mm Hg, and a room air oxygen reading of 100%. His physical examination is unremarkable. He has no abdominal tenderness, rebound, or guarding; there is no costovertebral angle tenderness. The thoracic and lumbar spine exams are normal. His genital examination reveals Tanner stage II; there is no scrotal edema, erythema, or tenderness. He is circumcised. The inguinal area has no obvious masses and there is no tenderness.

Imaging considerations

Imaging is useful to determine not only the presence of nephrolithiasis but also associated complications, such as ureteral obstruction and hydronephrosis. The primary imaging modalities utilized during the evaluation of a pediatric patient with suspected nephrolithiasis are generally available, including ultrasound and computed tomography (CT).