Differential Diagnosis for 90-year-old Male with Hip/Groin Pain and Swelling
- Single most likely diagnosis:
- Osteoarthritis: Given the patient's age and presentation of hip/groin pain and swelling, osteoarthritis is the most likely diagnosis. The presence of bilateral degenerative arthritis in hips on X-ray further supports this diagnosis.
- Other Likely diagnoses:
- Stress fracture: Although the patient does not have a history of trauma, stress fractures can occur in the elderly due to osteoporosis or other underlying conditions.
- Vascular causes (e.g., atherosclerosis): The patient's history of hyperlipidemia and impaired renal function increases the risk of vascular disease, which could contribute to hip/groin pain.
- Infection (e.g., septic arthritis): Although less likely, infection is a possible cause of hip pain and swelling, especially in the context of impaired renal function and diabetes mellitus.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Malignancy (e.g., metastatic disease): The presence of multiple pulmonary nodules raises concern for metastatic disease, which could be causing the patient's hip/groin pain.
- Aortic aneurysm or dissection: Although less common, aortic aneurysm or dissection could present with hip/groin pain and is a life-threatening condition that requires prompt diagnosis and treatment.
- Rare diagnoses:
- Osteonecrosis: This condition, also known as avascular necrosis, can cause hip pain and is more common in patients with a history of steroid use or excessive alcohol consumption.
- Paget's disease: A rare bone disorder that can cause hip pain and deformity, although it is less common in this age group.
- Bladder calculus causing referred pain: Although the X-ray showed a 2.4 cm bladder calculus, it is unlikely to be the primary cause of the patient's hip/groin pain, but it could be contributing to the patient's discomfort.