Differential Diagnosis for Right Flank Pain
Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stones): This is often the most common cause of acute flank pain, typically presenting with severe, crampy pain that may radiate to the groin. The pain is usually accompanied by nausea, vomiting, and sometimes hematuria.
Other Likely Diagnoses
- Pyelonephritis: An infection of the kidney, which can cause flank pain, fever, and other urinary symptoms. It's more common in women and those with underlying urinary tract issues.
- Musculoskeletal Strain: Overuse or injury to the muscles in the flank area can cause significant pain, especially if there's a history of heavy lifting or strenuous activity.
- Urinary Tract Infection (UTI): While more commonly associated with lower urinary tract symptoms, a UTI can cause flank pain if it ascends to the kidneys.
Do Not Miss Diagnoses
- Appendicitis (if pain is in the right lower quadrant): Although appendicitis typically presents with pain in the right lower quadrant, it can sometimes cause flank pain, especially if the appendix is retrocecal. Missing this diagnosis can lead to perforation and severe complications.
- Pulmonary Embolism: In rare cases, a pulmonary embolism can cause referred pain to the flank area, especially if the embolism is large and affects the upper lobes of the lungs. This is a life-threatening condition that requires immediate attention.
- Aortic Dissection or Aneurysm: These are rare but critical conditions that can cause severe flank pain due to the involvement of the aorta. They are more common in older patients with hypertension or a history of vascular disease.
Rare Diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension and flank pain.
- Renal Cell Carcinoma: A type of kidney cancer that can cause flank pain, hematuria, and a palpable mass, although it's often asymptomatic until late stages.
- Epididymitis or Orchitis: Inflammation of the epididymis or testis, which can cause flank pain that radiates to the groin, more common in younger men.
Each of these diagnoses has distinct characteristics and risk factors, and a thorough history, physical examination, and diagnostic tests (such as imaging and laboratory studies) are essential for making an accurate diagnosis and guiding treatment.