Case history

Case history

A 45-year-old man presents to the emergency department with a 1-hour history of sudden onset of left-sided flank pain radiating down toward his groin. The patient is writhing in pain, which is unrelieved by position. He also complains of nausea and vomiting.

Other presentations

Many patients with nephrolithiasis are actually asymptomatic, as their stone may be in the kidney and nonobstructing. In these patients, diagnosis may be made following imaging (CT scan, abdominal x-ray, renal ultrasound, etc.) for other reasons. In contrast, other patients may present with gross hematuria, evidence of an obstructive uropathy or sepsis with fever, tachycardia, and hypotension.

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