Differential Diagnosis for 42-year-old Obese Male with RUQ Pain
Single Most Likely Diagnosis
- Chronic right renal calculi: The patient's CT scan 2 weeks ago showed pinpoint non-obstructing right renal calculi, which could be causing the sharp, shooting pain in the right upper quadrant (RUQ) that radiates to the kidney area. The pain's characteristics and the patient's history of improved symptoms after a toradol injection support this diagnosis.
Other Likely Diagnoses
- Musculoskeletal strain: The patient's occupation as a truck driver and the onset of pain coinciding with attaching a truck to a trailer suggest a musculoskeletal strain, possibly involving the intercostal muscles or the abdominal wall.
- Gallbladder disease: Although the patient's liver enzymes are improving, the initial elevation and the patient's history of increased alcohol use could suggest gallbladder disease, such as chronic cholecystitis.
- Hepatic steatosis: The patient's obesity and history of elevated liver enzymes could indicate hepatic steatosis, which may cause RUQ pain.
Do Not Miss Diagnoses
- Peptic ulcer disease: Although the patient's lipase level was within normal limits, a peptic ulcer could still be present and cause severe abdominal pain. Missing this diagnosis could lead to serious complications, such as perforation or bleeding.
- Hepatic or renal malignancy: Although less likely, it is essential to consider the possibility of a malignant process, especially given the patient's history of chronic pain and recent onset of RUQ pain.
- Pulmonary embolism: The patient's history of syncope and chronic back pain could increase the risk of pulmonary embolism, which may cause referred pain to the RUQ.
Rare Diagnoses
- Intercostal neuralgia: The patient's sharp, shooting pain and radiation to the back could suggest intercostal neuralgia, a rare condition characterized by inflammation or irritation of the intercostal nerves.
- Sickle cell disease: Although unlikely, sickle cell disease could cause recurrent episodes of abdominal pain, including RUQ pain, due to vaso-occlusive crises.