Differential Diagnosis for 83-year-old Female with Right Hip Pain
Single Most Likely Diagnosis
- Osteoarthritis: Although the hip X-ray shows no significant arthritic changes, osteoarthritis is a common cause of hip pain in elderly patients, and radiographic findings may not always correlate with symptoms. The patient's age and presentation of hip pain radiating to the leg are consistent with this diagnosis.
Other Likely Diagnoses
- Lumbar Radiculopathy: The patient's hip pain radiating to the right leg could be due to nerve root compression in the lumbar spine, which is a common cause of radiating pain in the elderly.
- Trochanteric Bursitis: Inflammation of the bursa over the trochanteric region of the femur can cause hip pain that radiates down the leg, and is a common condition in older adults.
- Chronic Kidney Disease (CKD) related bone pain: The patient's elevated creatinine and decreased eGFR suggest CKD, which can cause bone pain due to secondary hyperparathyroidism and osteodystrophy.
Do Not Miss Diagnoses
- Hip Fracture: Although the X-ray shows no acute fracture, a stress fracture or an occult fracture not visible on X-ray could be present, and is a potentially life-threatening condition in an elderly patient.
- Avascular Necrosis: This condition can cause hip pain and is more common in patients with risk factors such as age, female sex, and possibly CKD.
- Infection (e.g. Septic Arthritis): Although the soft tissues are reported as unremarkable, infection is a potentially life-threatening condition that must be considered, especially in an elderly patient with CKD.
Rare Diagnoses
- Paget's Disease: A rare condition that can cause bone pain and deformity, although it is less common in this age group.
- Bone Metastases: Although rare, bone metastases from a primary cancer could cause hip pain, and should be considered in the differential diagnosis, especially if there are other symptoms or risk factors present.