Differential Diagnosis for 74 Year Old Male with Flank Pain
Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stones): This is a common cause of flank pain in adults, especially in older individuals. The pain is often severe and can radiate to the groin. The patient's age and symptom presentation make this a likely diagnosis.
Other Likely Diagnoses
- Pyelonephritis: An infection of the kidney, which can cause flank pain, fever, and other urinary symptoms. Older adults are more susceptible to urinary tract infections due to decreased immunity and potential urinary retention issues.
- Musculoskeletal Strain: Given the patient's age, musculoskeletal issues such as a strain in the back or side could cause flank pain. This is more likely if the pain is related to activity or movement.
- Degenerative Disc Disease or Spondylosis: These spinal conditions can cause referred pain to the flank area, especially if there is nerve root compression involved.
Do Not Miss Diagnoses
- Abdominal Aortic Aneurysm (AAA): Although less common, an AAA can present with flank pain, especially if it is leaking or ruptured. This is a medical emergency that requires immediate attention.
- Renal Cell Carcinoma: Cancer of the kidney can cause flank pain, hematuria, and a palpable mass. It's crucial not to miss this diagnosis due to its significant implications for treatment and prognosis.
- Pulmonary Embolism: In some cases, a pulmonary embolism can refer pain to the flank area if the embolism involves the upper lobes of the lungs. This is a life-threatening condition that requires prompt diagnosis and treatment.
Rare Diagnoses
- Polycystic Kidney Disease (PKD): A genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys, which can cause flank pain, hematuria, and kidney failure. It's less common but should be considered in the differential, especially if there's a family history.
- Renal Infarction: This is a rare condition where the blood supply to the kidney is interrupted, leading to tissue death. It can cause severe flank pain and is often associated with conditions like atrial fibrillation or vasculitis.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, sweating, palpitations, and flank pain due to catecholamine release.