Costovertebral angle

Costovertebral angle (CVA) is an anatomical term that refers to the acute angle formed on either side of the human body between the twelfth rib and the vertebral column. The costovertebral angle is of significant clinical importance as it is a site commonly examined for tenderness, which can indicate problems within the kidney or surrounding structures.

Anatomy

The costovertebral angle is located at the back, just below the rib cage. It is bounded by the lower border of the twelfth rib and the transverse process of the upper lumbar vertebrae, typically the first lumbar vertebra (L1). This area covers the lower part of the kidney, making it a crucial point for assessing kidney health.

Clinical Significance

Tenderness in the costovertebral angle is often a sign of renal pathology. The most common condition associated with CVA tenderness is pyelonephritis, an infection of the kidney typically caused by bacteria that have ascended from the bladder. Other conditions that may cause CVA tenderness include:

• Kidney stones (renal calculi) - Hard deposits formed in the kidney that can cause pain when passing through the urinary tract.
• Hydronephrosis - Swelling of a kidney due to a build-up of urine.
• Glomerulonephritis - Inflammation of the tiny filters in the kidneys (glomeruli).
• Renal abscess - A localized collection of pus caused by an infection in the kidney.

Assessment

CVA tenderness is assessed through the percussion test, where a healthcare provider uses the side of their closed fist to gently tap the area of the costovertebral angle. Pain or tenderness elicited by this action is considered a positive sign of a problem in the kidney or adjacent structures.

Differential Diagnosis

When a patient presents with CVA tenderness, it is crucial to differentiate between the various causes. This involves a combination of clinical assessment, laboratory tests (such as urinalysis, blood tests), and imaging studies (like ultrasound or CT scans) to identify the underlying issue accurately.

Treatment

The treatment for conditions presenting with CVA tenderness varies depending on the diagnosis. For infections such as pyelonephritis, antibiotics are the mainstay of treatment. In the case of kidney stones, management may include pain relief, hydration, and in some cases, procedures to remove or break up the stones. Treatment for other conditions like hydronephrosis or glomerulonephritis will depend on the underlying cause.

Prevention

Preventive measures for conditions causing CVA tenderness include maintaining good hydration, practicing safe sex to reduce the risk of urinary tract infections, and managing underlying health conditions that may contribute to kidney issues.