Differential Diagnosis for 90-year-old Male with Hip/Groin Pain
Single most likely diagnosis
- Osteoarthritis: Given the patient's age and the gradual onset of hip/groin pain without a history of trauma, osteoarthritis is a likely cause. The improvement in pain with Tylenol also supports this diagnosis.
Other Likely diagnoses
- Trochanteric bursitis: This condition is common in older adults and can cause hip and groin pain, especially if the patient has been active or has changed their activity level.
- Stress fracture: Although the patient denies any trauma, stress fractures can occur without significant injury, especially in older adults with osteoporosis or other underlying bone diseases.
- Lymphedema or venous insufficiency: Given the swelling and the patient's history of chronic diseases, lymphedema or venous insufficiency could be contributing to the patient's symptoms.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic aneurysm or aortic dissection: Although less likely, these conditions can present with groin pain and are life-threatening if not promptly diagnosed and treated.
- Infection (e.g., osteomyelitis, septic arthritis): Despite the lack of fever, infection should be considered, especially in an older adult with multiple comorbidities.
- Malignancy (e.g., metastatic disease to the bone): Given the patient's history of lung nodules, metastatic disease should be considered, especially if the pain is persistent or worsening.
Rare diagnoses
- Psoas abscess: A rare condition that can cause groin pain, often associated with underlying infections or inflammatory conditions.
- Spinal stenosis: Although more commonly associated with back and leg pain, spinal stenosis can cause groin pain, especially if the patient has a history of spinal disease or degeneration.