Differential Diagnosis
The patient presents with a 4-week history of right upper quadrant abdominal pain, which worsens with pressure and radiates to the back, suggesting a possible renal or musculoskeletal origin. The recent CT abdomen and pelvis with IV contrast revealed a pinpoint non-obstructing right renal calculus. Based on the provided information, the differential diagnosis can be categorized as follows:
- Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stone): The presence of a pinpoint non-obstructing right renal calculus on the CT scan, along with the patient's symptoms of sharp, shooting pain in the right upper quadrant that radiates to the back, supports this diagnosis. The pain level and characteristics, as well as the relief with Toradol injection, are consistent with renal colic associated with a kidney stone.
- Other Likely Diagnoses
- Musculoskeletal Pain: The patient's pain worsening with palpation and pressure under the ribs, and the radiation of pain to the back, could also suggest a musculoskeletal origin, such as costochondritis or a rib strain.
- Gastrointestinal Issues: Although the CT scan did not show any acute gastrointestinal abnormalities, the patient's symptoms could also be related to gastrointestinal issues such as peptic ulcer disease or gastroesophageal reflux disease (GERD), especially given the location and radiation of the pain.
- Do Not Miss Diagnoses
- Pulmonary Embolism: Although the CT scan did not show any evidence of pulmonary embolism, and the patient does not have typical symptoms such as fever or nausea, it is crucial to consider this diagnosis due to its high mortality rate if missed.
- Aortic Dissection: The patient's severe pain and radiation to the back could also suggest an aortic dissection, although the CT scan reported the aorta as normal caliber. This diagnosis is critical to rule out due to its potential for catastrophic consequences.
- Rare Diagnoses
- Pancreatic or Adrenal Gland Pathology: Although the CT scan reported these organs as normal in size, shape, and position, rare conditions such as pancreatic or adrenal gland tumors could present with similar symptoms.
- Inflammatory or Infectious Processes: Conditions like pyelonephritis or abscesses in the kidney or surrounding tissues could also cause the patient's symptoms, although the CT scan and lack of fever make these less likely.