Differential Diagnosis for 70-year-old Male with Back Pain
- Single most likely diagnosis
- Musculoskeletal strain: The patient's recent activity of painting and moving furniture, followed by back pain localized to the left lumbar region, suggests a mechanical cause for his symptoms. The improvement with Aleve (naproxen) further supports this diagnosis, as it is an anti-inflammatory medication often used for musculoskeletal pain.
- Other Likely diagnoses
- Degenerative disc disease or lumbar spondylosis: Given the patient's age and history of obesity, which can exacerbate wear and tear on the spine, degenerative changes in the lumbar spine could be contributing to his back pain.
- Prostate cancer metastasis: Although the patient has a history of prostate cancer, the absence of systemic symptoms such as fever, weight loss, or radiculopathy makes this less likely. However, it remains a consideration given his past medical history.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal epidural abscess or osteomyelitis: Although the patient is afebrile and denies recent illness, infection in the spine can present subtly, especially in older adults. The absence of fever does not rule out these conditions, and they require prompt diagnosis and treatment to prevent serious complications.
- Abdominal aortic aneurysm (AAA): Back pain can be a presenting symptom of an AAA, especially if it is leaking or ruptured. The patient's age, gender, and history of hyperlipidemia and obesity increase his risk for AAA.
- Spinal fracture: Even without a reported trauma, osteoporotic fractures can occur spontaneously or with minimal trauma in older adults, especially those with a history of cancer, which can affect bone density.
- Rare diagnoses
- Lumbar spinal stenosis: While this condition can cause back pain, it typically presents with radiculopathy, which the patient denies. However, it remains a possibility, especially if the stenosis is not severe enough to cause neurological symptoms.
- Pancreatic or renal cancer: These cancers can cause back pain due to metastasis or local invasion. Although less likely given the patient's presentation, they should be considered in the differential diagnosis, especially if other causes are ruled out.