Introduction & Objectives
Urolithiasis in children occurs with frequency of 0.1 to 5% of the population. Adolescents present similar symptoms to adult patients, among them renal colic (acute, severe flank pain, which radiates to the groin).
Material & Methods
Medical records analysis of 15-year-old patient admitted to Pediatric, Nephrology and Allergology Department, Military Institute of Medicine due to suspicion of urolithiasis and with symptoms of left flank pain treated as renal colic.
15-year-old patient admitted to Pediatric, Nephrology and Allergology Department, Military Institute of Medicine due to suspicion of urolithiasis and with symptoms of left flank pain. The pain had been observed from 7 months. It had recurring character, had been increasing in sitting position and had been waking the patient from sleep. Before the admission the boy was hospitalized in three centers (once in July 2016, twice in September 2016). X-ray examination revealed a small calcification in the left kidney, but in repeated ultrasound examination no kidney stones were detected. Due to increased inflammatory parameters, he was treated twice with antibiotics (Cefuroxime, Amikacin). Analgesics and antispasmodic drugs were administered almost continuously but without any significant effect on reported symptoms. In admission there were no stones in US examination, so abdomen computed tomography (CT) was performed. Urolithiasis was not reported, but abnormal mass on the left-side of wall chest was found. The study was extended to computed tomography of the chest, where mediastinal tumour (6cm x 6cm x 8cm in diameter), extending from the IX to VIII rib with rib’s destruction, was identified. The patient was referred to an oncology department where pathologic analysis revealed Ewing sarcoma / PNET tumour.
Symptoms mimicking renal colic are not always caused by urolithiasis. However posterior mediastinal tumours in children are significantly less common than renal stones, we should always check all potential reasons of symptoms reported by our patients. Ultrasonography remains the first study of choice, but CT is indicated in patients with persistent symptoms of urolithiasis and nondiagnostic utrasound.