Intended for healthcare professionals

Endgames Spot Diagnosis

A pain in the back

BMJ 2018; 362 doi: (Published 19 July 2018) Cite this as: BMJ 2018;362:k2868
  1. Nadia Hitchen, general medicine registrar,
  2. Harriet Weststrate, house officer,
  3. Arshad Sheriff, specialist radiology registrar
  1. Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to NHitchen{at}
Video 1

Axial contrast enhanced computed tomography of the abdomen and pelvis demonstrating a left renal infarct. A 2 mm non-obstructive calculus is identified within the mid-pole of the right kidney. The remainder of the solid abdominal organs are unremarkable.

A 72 year old man with a history of atrial fibrillation was admitted with a basal ganglia interventricular haemorrhage. Warfarin was stopped on admission. Five days after presentation, he developed gradual, cramping, left sided abdominal pain radiating to the flank with urinary frequency but no haematuria. His inflammatory markers were elevated, serum urea and creatinine were normal, and urine microscopy was negative for blood, white cells, and bacteria. A computed tomography scan was arranged (fig 1). What does it show?

Fig 1

Axial computed tomography abdominal slice


Wedge shaped low attenuation areas …

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