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Case 49: Loin to groin pain

A 73 year old man presented to the emergency department with right loin pain radiating to the groin. He is previously fit and well but is now pale and sweaty. The emergency department have arranged a KUB xray but as he has not voided a urinalysis has not been performed.

1. What does the xray show?

There is no radio-opaque density along the line of the right ureter. There is however calcification in the wall of an abdominal aortic aneurysm.

2. What would you tell the emergency department resident?

To call a vascular surgeon and to always consider the diagnosis of ruptured AAA before ureteric colic in the future. This applies particularly to elderly men. Blood tracking in the retroperitoneum may mimic the pain of a ureteric calculus.