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.

Costovertebral angle tenderness
Medical diagnostics
The costovertebral angle is located in the back between the 12th rib and the spine
Purposetest in which pain is elicited by percussion

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.[1][2][3][4] In Italy, Greece and in Brazil it is called Giordano's test (Manovra di Giordano).


  1. Oh, Timothy T.; Schmitz, Robert L. (1993). The Remarkable surgical practice of John Benjamin Murphy. Urbana: University of Illinois Press. ISBN 0-252-01958-X.
  2. Musana KA, Yale SH (August 2005). "Murphy's Sign". Clin Med Res. 3 (3): 132. doi:10.3121/cmr.3.3.132. PMC 1237152. PMID 16160065.
  3. Musana K, Yale SH (May 2005). "John Benjamin Murphy (1857 - 1916)". Clin Med Res. 3 (2): 110–2. doi:10.3121/cmr.3.2.110. PMC 1183442. PMID 16012130.

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