Diagnostic Approach to Right Flank Pain

Initial Evaluation and Diagnostic Imaging

The American College of Radiology recommends assessing pain characteristics, such as sudden onset, colicky pain, and radiation to the groin, in patients with right flank pain 1
Ultrasonography may be considered in specific situations, particularly when radiation exposure is a concern, with a sensitivity of 96% when combining findings of pyeloureteral dilation, direct stone visualization, and absence of ureteral ejaculation 2
MRI may be appropriate in cases where CT is contraindicated, with similar sensitivity and specificity to ultrasonography for certain conditions, and is useful for visualizing hepatic and biliary abnormalities not well-characterized on ultrasound 2

Non-urinary causes of right flank pain include right colonic diverticulitis, appendicitis, intestinal obstruction, and hepatobiliary conditions, which can be identified using imaging studies 1
The American Academy of Family Physicians suggests that treatment for non-stone pathology should be directed at the specific diagnosis identified by imaging, and may include surgical consultation for conditions like appendicitis or diverticulitis 1
When evaluating right flank pain that could be referred from the lower quadrant, consider appendicitis in the differential diagnosis, especially with fever and leukocytosis 3