Differential Diagnosis for Left Lumbar Pain in a 74-Year-Old Lady
Single Most Likely Diagnosis
- Musculoskeletal strain or osteoarthritis: Given the patient's age, musculoskeletal strain or osteoarthritis are common causes of lumbar pain due to wear and tear of the joints and muscles over time.
Other Likely Diagnoses
- Degenerative disc disease: This condition is prevalent in older adults and can cause lumbar pain due to the degeneration of the intervertebral discs.
- Kidney stones: Although more common in younger populations, kidney stones can occur at any age and may cause severe lumbar pain, typically radiating to the groin.
- Urinary tract infection (UTI): Older adults are more susceptible to UTIs, which can cause lumbar pain, especially if the infection involves the kidneys (pyelonephritis).
- Constipation: Constipation is common in older adults and can cause abdominal and lumbar discomfort.
Do Not Miss Diagnoses
- Abdominal aortic aneurysm (AAA): Although less common, AAA is a life-threatening condition that can cause lumbar or abdominal pain and is more prevalent in older adults, especially those with a history of smoking.
- Pulmonary embolism: While typically presenting with respiratory symptoms, pulmonary embolism can occasionally cause referred pain to the lumbar region and is a critical diagnosis not to miss.
- Spinal fracture: Osteoporotic spinal fractures are more common in older adults, especially postmenopausal women, and can cause sudden onset of lumbar pain.
- Infectious discitis or osteomyelitis: These infections of the spine can cause severe lumbar pain and are more common in older adults or those with compromised immune systems.
Rare Diagnoses
- Pancreatic cancer: While rare, pancreatic cancer can cause lumbar pain due to the tumor's location and is more common in older adults.
- Spinal tumors: Both primary and metastatic spinal tumors can cause lumbar pain and are considered in the differential diagnosis, especially if there's a known history of cancer.
- Endometriosis: Although rare in postmenopausal women, endometriosis can cause cyclic lumbar pain if the endometrial implants are located near the spine or pelvic nerves.