Differential Diagnosis for 32yo F with LUQ Swelling and Tenderness
- Single most likely diagnosis
- Splenic infarction or splenomegaly: The patient's symptoms of left upper quadrant (LUQ) swelling and tenderness, worsened by leaning on the left side, suggest involvement of the spleen. Splenic infarction or splenomegaly could cause these symptoms, especially if the patient has an underlying condition such as a hematological disorder or liver disease.
- Other Likely diagnoses
- Gastrointestinal issues (e.g., gastritis, peptic ulcer disease): Although the patient denies nausea, vomiting, or changes in bowel movements, gastrointestinal issues could still cause LUQ tenderness. The relief of pain with position change might suggest a gastrointestinal origin.
- Costochondritis or musculoskeletal pain: The patient's pain worsening with leaning on the left side and improving with position change could indicate costochondritis or musculoskeletal pain in the left upper quadrant.
- Pancreatitis: Although less likely given the lack of nausea and vomiting, pancreatitis could still present with LUQ tenderness and should be considered, especially if the patient has a history of gallstones or excessive alcohol use.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ruptured spleen or splenic aneurysm: These conditions are medical emergencies that require immediate attention. Although less likely, they could present with LUQ tenderness and swelling, especially if the patient has a history of trauma or underlying vascular disease.
- Pulmonary embolism (with referred pain): While less common, pulmonary embolism can cause referred pain to the left upper quadrant, especially if the patient has a history of deep vein thrombosis or is at high risk for thromboembolic events.
- Aortic dissection (with referred pain): Similar to pulmonary embolism, aortic dissection can cause referred pain to the left upper quadrant and is a medical emergency that requires prompt diagnosis and treatment.
- Rare diagnoses
- Diaphragmatic rupture or eventration: These conditions are rare but could cause LUQ tenderness and swelling, especially if the patient has a history of trauma or underlying diaphragmatic disease.
- Retroperitoneal fibrosis or tumor: Although rare, these conditions could cause LUQ tenderness and swelling, especially if the patient has a history of malignancy or underlying inflammatory disease.