Costovertebral angle tenderness
Costovertebral angle tenderness (CVAT), also known as CVA tenderness, Murphy's punch sign, Pasternacki's sign, or Goldflam's sign (Latin: succusio renalis), is a medical test in which pain is elicited by percussion of the area of the back overlying the kidney (the costovertebral angle, an angle made by the vertebral column and the costal margin). The test is positive in people with an infection around the kidney (perinephric abscess), pyelonephritis, hemorrhagic fever with renal syndrome or renal stone. Because the kidney is directly anterior to this area, known as the costovertebral angle, tapping disturbs the inflamed tissue, causing pain.
This medical test was first described by the American surgeon John Benjamin Murphy in 1884, but in the Post-Soviet states and Eastern Europe, it is often called Pasternacki's sign, after Belorussian internist Fiodor Ignatjevich Pasternacki (1845–1902), who described it during his rounds in a regional hospital in Minsk in 1888. In Poland it is often called Goldflam's sign, after Polish neurologist Samuel Goldflam, who described it in 1900. In Italy it is called Giordano's test (Manovra di Giordano).
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