November Case #1

A 62 y/o man presents to the ED with complaints of right flank pain which began several hours prior. The pain is localized, constant and non-radiating. He denies dysuria, hematuria or urinary frequency or urgency. He denies CP, SOB, F/C, N/V, or any other complaints.

PMHx: HTN, DM, "kidney problem"
PSHx: none
Family Hx: unknown
Social Hx: lives alone, denies alcohol, tobacco and drugs

PE:
Gen: WNWD, WM, NAD
Chest: CTA B, nonlabored
CV: RRR, no M/R/G/
Abd: soft, NTND, +BS, no CVAT
Ext: no C/C/E

What's your differential diagnosis?



Bedside ultrasound illustrates the following:





What is the differential for this ultrasound exam?

What other structures should you investigate based on this scan?