Differential Diagnosis for 68-year-old Female with Intermittent Right Mid Back Pain
- Single most likely diagnosis:
- Musculoskeletal back pain: This is the most likely diagnosis given the patient's age, symptoms of intermittent back pain, and improvement with heating pad. The absence of any recent trauma or injury and the lack of systemic symptoms such as fever or weight loss also support this diagnosis.
- Other Likely diagnoses:
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause mid-back pain, especially if the pain is exacerbated by movement or deep breathing.
- Pulmonary embolism (less likely due to lack of systemic symptoms but still a consideration): Although the patient denies any recent trauma or injury, pulmonary embolism can present with back pain, especially if the embolism is located in the upper lobes.
- Gastroesophageal reflux disease (GERD): GERD can cause mid-back pain, especially if the pain is exacerbated by eating or lying down.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Aortic dissection: Although rare, aortic dissection is a life-threatening condition that can present with sudden, severe back pain. The patient's history of hypertension (associated with hyperlipidemia and diabetes) increases her risk.
- Spinal metastasis: Given the patient's history of breast cancer, spinal metastasis is a possibility, especially if the pain is persistent and worsening over time.
- Pneumonia: Pneumonia can cause mid-back pain, especially if the infection is located in the upper lobes. The patient's age and comorbidities increase her risk.
- Rare diagnoses:
- Pancreatic cancer: Pancreatic cancer can cause mid-back pain, especially if the tumor is located in the body or tail of the pancreas.
- Herpes zoster: Shingles can cause mid-back pain, especially if the rash is located in the thoracic dermatomes.
- Osteoporotic compression fracture: Although rare, osteoporotic compression fractures can cause mid-back pain, especially if the patient has a history of osteoporosis or steroid use.