Differential Diagnosis
The patient's symptoms of a potential UTI in December 2019, which lasted for at least 10 days and included severe pain that worsened on a plane, suggest several possible diagnoses. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Urinary Tract Infection (UTI): The initial symptoms of pain and duration are consistent with a UTI, although the change in pain severity and characteristics, especially in relation to air travel, might suggest other contributing factors or a different diagnosis altogether.
Other Likely diagnoses
- Kidney Stone: The severe pain, especially if it worsened with the change in pressure during the flight, could indicate a kidney stone. The movement of a stone could cause severe pain that changes in intensity and location.
- Interstitial Cystitis: This condition causes bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can be chronic and might have been exacerbated by the flight, leading to a change in pain perception.
- Prolapsed Uterus or Other Gynecological Issues: Depending on the patient's gender and reproductive health history, conditions like a prolapsed uterus could cause pelvic pain that might worsen with changes in pressure or position, such as during a flight.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism: Although less likely given the initial presentation, the worsening of pain during a flight could potentially be related to a pulmonary embolism, especially if the patient has risk factors for deep vein thrombosis (DVT) such as recent immobilization or other predisposing conditions.
- Appendicitis or Other Surgical Abdominal Conditions: If the pain is more abdominal than initially suggested, conditions like appendicitis could be life-threatening if not promptly diagnosed and treated.
- Ovarian Torsion: In individuals with ovaries, ovarian torsion is a medical emergency that can cause severe pelvic pain. It might not be directly related to the flight but is crucial to rule out given the severity of pain described.
Rare diagnoses
- Endometriosis: While not typically associated with acute changes in pain due to air travel, endometriosis can cause chronic pelvic pain and might be considered if other diagnoses are ruled out and the patient continues to experience pain.
- Adhesions or Other Post-Surgical Complications: If the patient has a history of abdominal or pelvic surgery, adhesions could cause bowel obstruction or other complications leading to severe pain, although these would be less likely to be directly exacerbated by air travel.