Differential Diagnosis for Pain under Right Rib
- Single most likely diagnosis
- Gallbladder disease (cholecystitis or cholelithiasis): This is a common cause of right upper quadrant pain, which can radiate to the area under the right rib. The pain is often exacerbated by fatty foods and can be accompanied by nausea and vomiting.
- Other Likely diagnoses
- Hepatitis: Inflammation of the liver can cause pain in the right upper quadrant, which may be felt under the right rib. This can be due to viral, alcoholic, or autoimmune causes.
- Peptic ulcer disease: Although more commonly associated with epigastric pain, peptic ulcers can cause referred pain to the right upper quadrant.
- Right lower lobe pneumonia: Infection in the lower lobe of the right lung can cause pain that is referred to the area under the right rib due to the shared nerve roots.
- Musculoskeletal strain: Strain or injury to the muscles or ribs on the right side can cause localized pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Pulmonary embolism: Although less common, a pulmonary embolism can cause sudden onset of sharp chest pain that may radiate to the area under the right rib, especially if the embolism is located in the lower lobe of the right lung.
- Myocardial infarction: Right ventricular infarction can cause pain that is referred to the right upper quadrant.
- Aortic dissection: This is a rare but life-threatening condition where the aorta tears, and the pain can be referred to various areas, including under the right rib.
- Rare diagnoses
- Liver cancer or metastasis: Although rare, cancer in the liver can cause pain in the right upper quadrant.
- Hydatid cyst of the liver: A parasitic infection that can cause cysts to form in the liver, leading to pain under the right rib.
- Right diaphragmatic irritation (e.g., due to a subphrenic abscess): Inflammation or infection under the diaphragm can cause referred pain to the area under the right rib.