Differential Diagnosis for 27-year-old Female with Right Flank Pain
Single most likely diagnosis
- Pyelonephritis or Kidney Infection: The patient's symptoms of constant right flank pain, costovertebral angle (CVA) tenderness, and the presence of leukocytes and trace blood in the urine are highly suggestive of a kidney infection. The pain in the right lower quadrant (RLQ) with palpation and rebound tenderness may indicate involvement or irritation of the surrounding tissues.
Other Likely diagnoses
- Nephrolithiasis (Kidney Stones): The patient's history of intermittent flank pain and the presence of trace blood in the urine could be indicative of kidney stones, which are a common cause of flank pain.
- Appendicitis: Although the pain is primarily in the flank, the presence of RLQ pain and rebound tenderness could suggest appendicitis, especially if the appendix is retrocecal.
- Ovarian Cyst or Torsion: The patient's sex and the location of the pain could suggest an ovarian pathology, such as a cyst or torsion, which can cause severe pain and tenderness.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic Pregnancy: Although the patient's symptoms do not strongly suggest pregnancy, it is crucial to consider ectopic pregnancy in any female of childbearing age presenting with abdominal pain, as it is a life-threatening condition.
- Ruptured Aneurysm or Aortic Dissection: These vascular emergencies can present with severe flank or abdominal pain and are life-threatening if not promptly diagnosed and treated.
- Sepsis: The presence of leukocytes and trace blood in the urine could indicate a severe infection, and sepsis should be considered, especially if the patient shows signs of systemic illness.
Rare diagnoses
- Renal Infarction: This is a rare condition where the kidney tissue dies due to a lack of blood supply, which can cause severe flank pain and could be considered in the differential diagnosis.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic pain and other symptoms, although it is less likely given the patient's presentation.