The costovertebral angle (CVA) is an anatomical area on the back. It is a landmark assessed by healthcare professionals during physical examinations. Assessing this region provides insights into potential health concerns, especially those involving structures beneath it, by identifying discomfort or pain.
Anatomy and Location
The costovertebral angle is on the back, at the lower edge of the rib cage. It is the angle formed where the twelfth rib meets the vertebral column. The term “costo” refers to the ribs, and “vertebral” relates to the vertebrae.
The twelfth rib, often called a floating rib, does not connect directly to the breastbone. Instead, it ends freely. The angle is formed by the junction of this twelfth rib and the transverse processes of the first lumbar vertebra (L1), or sometimes the last thoracic vertebra (T12). Kidneys lie just beneath this landmark, making the costovertebral angle an important area for evaluating kidney health.
Clinical Importance
The costovertebral angle is medically relevant because pain or tenderness in this region can indicate various underlying health issues. Kidneys are directly behind this area, making them a primary source of discomfort. Conditions such as kidney infections, known as pyelonephritis, commonly cause pain. A bacterial infection, often originating from a urinary tract infection, can ascend to the kidneys and manifest as CVA tenderness.
Kidney stones also frequently cause pain in the costovertebral angle. Their movement or obstruction can cause intense pain. Other kidney-related causes include renal abscesses or polycystic kidney disease. Musculoskeletal issues, such as muscle strains or spinal problems, can also contribute to pain in this region, though kidney-related causes are often the initial concern.
Examination and Interpretation
Healthcare professionals examine the costovertebral angle to assess for tenderness. This assessment typically involves a technique called percussion. The examiner places one hand over the CVA and gently taps it with the other fist. This maneuver is performed on both sides of the spine to compare findings.
A positive finding, costovertebral angle tenderness, occurs when percussion elicits a sharp, localized pain. This suggests inflammation or distention of the kidney capsule, often indicating a kidney infection or kidney stone. While CVA tenderness points to kidney pathology, it is not the sole diagnostic factor; medical evaluation is essential, warranting a visit to a healthcare provider for further diagnostic tests, such as urinalysis or imaging studies.