Differential Diagnosis for Right Thigh Pain
The patient's presentation of recurrent pain, decreased range of motion, and a palpable mass after a traumatic injury suggests several possible diagnoses. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- C. Heterotopic bone formation: This condition, also known as myositis ossificans, is a common complication of muscle trauma, especially in young athletes. The patient's history of severe pain and swelling after a soccer injury, followed by complete resolution and then recurrent pain with a palpable mass, is consistent with heterotopic bone formation. The mass is often indurated and mobile, and pain can be reproduced by passive flexion of the knee.
- Other Likely diagnoses
- A. Complete quadriceps muscle tear: Although less likely given the patient's ability to move the knee and the presence of a palpable mass, a complete quadriceps muscle tear could still be considered, especially if the initial injury was severe.
- B. Femoral vein thrombosis: This condition could cause swelling and pain in the thigh, but it would typically be associated with other symptoms such as skin erythema, warmth, and possibly decreased peripheral pulses, which are not present in this case.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Necrotizing myositis: This is a rare but life-threatening condition that requires prompt diagnosis and treatment. Although the patient's presentation is not typical for necrotizing myositis (e.g., no fever, no skin erythema), it's essential to consider this diagnosis due to its potential severity.
- E. Neoplastic bone tumor: Although unlikely, a neoplastic bone tumor could present with a palpable mass and pain. It's crucial to rule out this possibility, especially if the patient's symptoms persist or worsen over time.
- Rare diagnoses
- Other rare conditions, such as compartment syndrome or infectious myositis, could also be considered, but they are less likely given the patient's presentation and the absence of other symptoms.