Differential Diagnosis for Low Back Pain with Swelling and History of Pelvic Venous Congestion
- Single most likely diagnosis
- Ovarian vein thrombosis: This condition is a strong consideration given the history of pelvic venous congestion. Ovarian vein thrombosis can cause low back pain and swelling due to the obstruction of blood flow, leading to inflammation and potential infection.
- Other Likely diagnoses
- Pelvic varices: Varices in the pelvic region can cause venous congestion, leading to pain and swelling. This condition is more common in women, especially those with a history of pregnancy or pelvic surgery.
- Chronic venous insufficiency: This condition occurs when the veins have problems returning blood to the heart, leading to congestion and swelling in the affected area, which could include the lower back and pelvic region.
- Nephrotic syndrome: Although less directly related to pelvic venous congestion, nephrotic syndrome can cause significant swelling (edema) throughout the body, including the lower back, due to kidney dysfunction.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Deep vein thrombosis (DVT) with pulmonary embolism risk: While DVT typically affects the legs, it can occur in the pelvic veins and has a risk of breaking loose and causing a pulmonary embolism, which is life-threatening.
- Ovarian torsion: This is a surgical emergency where the ovary twists around its ligaments, cutting off blood supply. It can cause severe pain and swelling but is less directly related to venous congestion.
- Retroperitoneal hemorrhage: Bleeding into the space behind the peritoneum can cause back pain and swelling, and while it's not directly related to venous congestion, it's a critical condition that requires immediate attention.
- Rare diagnoses
- May-Thurner syndrome: A rare condition where the left common iliac vein is compressed by the right common iliac artery, leading to venous congestion and potentially causing low back pain and swelling.
- Nutcracker syndrome: Another rare condition where the left renal vein is compressed between the abdominal aorta and the superior mesenteric artery, leading to venous congestion and potential back pain.