Differential Diagnosis for Sudden Onset Back Pain, Dizziness, and Pulsing in Lower Abdomen

• Single Most Likely Diagnosis
  • Aortic dissection: This condition is characterized by a sudden, severe tear in the inner layer of the aorta, which can cause sudden onset back pain, dizziness due to potential hypotension or decreased blood flow to the brain, and pulsing sensations in the lower abdomen if the dissection extends to the abdominal aorta.
• Other Likely Diagnoses
  • Kidney stone (nephrolithiasis): Sudden onset back pain, especially if radiating to the groin, could be indicative of a kidney stone. Dizziness might occur due to pain-induced hypotension or dehydration. The pulsing sensation could be mistaken for the pain associated with the stone moving.
  • Ovarian torsion (in females): This is a gynecological emergency where the ovary twists around its ligaments, cutting off blood supply. It can cause sudden, severe lower abdominal pain, which might radiate to the back, and could potentially lead to dizziness due to pain or decreased blood pressure.
  • Pulmonary embolism: Although more commonly associated with chest pain and shortness of breath, a large pulmonary embolism can cause sudden onset back pain if it affects the pulmonary arteries near the spine, and dizziness due to decreased cardiac output.
• Do Not Miss Diagnoses
  • Ruptured abdominal aortic aneurysm (AAA): Similar to aortic dissection, a ruptured AAA can cause sudden onset back pain and abdominal pulsing due to the aneurysm pressing on surrounding structures or leaking blood. Dizziness would result from significant blood loss.
  • Ectopic pregnancy (in females): This is a life-threatening condition where the embryo implants outside the uterus, often causing severe lower abdominal pain, which might be accompanied by back pain, dizziness due to internal bleeding, and a pulsing sensation due to the embryo's location.
  • Spinal epidural hematoma: Although rare, this condition involves bleeding into the space surrounding the spinal cord, which can cause sudden back pain and neurological symptoms, including dizziness if the hematoma compresses spinal cord structures affecting balance and blood pressure regulation.
• Rare Diagnoses
  • Pancreatitis: Inflammation of the pancreas can cause severe upper and middle back pain radiating to the abdomen, nausea, vomiting, and potentially dizziness due to dehydration or electrolyte imbalances. A pulsing sensation might be less common but could be related to the inflammatory process.
  • Retroperitoneal hemorrhage: Bleeding into the retroperitoneal space can cause back pain, abdominal pain, and potentially dizziness due to blood loss. The pulsing sensation could be related to the expanding hematoma pressing on abdominal structures.