Costovertebral angle tenderness

Physical exam

To test for CVA tenderness, the examiner first applies gentle pressure to the region inside of the CVA with their finger. If gentle pressure does not elicit tenderness, the examiner places one hand over the region inside the CVA and taps that hand gently with the closed fist of the other hand.

Differential diagnosis

CVA tenderness often indicates kidney pathology, but it may result from other medical problems. CVA tenderness is often present in acute pyelonephritis. CVA tenderness may be present in patients who have a kidney stone, a stone in the ureter, a ureteropelvic junction obstruction, a kidney abscess, a urinary tract infection, and vesicoureteral reflux. CVA tenderness is also present in patients who have retrocecal appendicitis and retroperitoneal abscesses. In patients with sickle cell disease, blockage of blood flow to the kidney may cause CVA tenderness.

A lack of CVA tenderness in patients with low back pain supports a diagnosis other than kidney pathology.

History

This medical test was first described by the American surgeon John Benjamin Murphy in 1884.

In the Post-Soviet states and Eastern Europe it is often called Pasternacki's sign after Belarusian internist Fiodor Ignatjevich Pasternacki, who described it during his rounds in a regional hospital in Minsk in 1888.

In Italian the manouvre is referred to as "Giordano's sign", after the Italian physician Davide Giordano.

In Poland, it is often called Goldflam's sign after Polish neurologist Samuel Goldflam, who described it in 1900.