Differential Diagnosis for 30-year-old Female with Right Lower Quadrant Abdominal Pain
- Single Most Likely Diagnosis
- Pelvic Inflammatory Disease (PID): The presence of prominent pelvic lymph nodes and possible pelvic congestion on CT, along with the patient's symptoms of right lower quadrant abdominal pain, suggests an inflammatory process. The normal appendix and bowel make other causes of abdominal pain less likely, and the absence of evidence of torsion or other ovarian pathology points towards an infection or inflammation as the cause.
- Other Likely Diagnoses
- Ovarian Cyst: The incidental finding of a left ovarian follicle could be related to the patient's pain, especially if the cyst is large or if there are concerns about potential rupture or leakage, which could cause irritation and pain.
- Endometriosis: This condition can cause chronic pelvic pain and could be considered given the patient's age and symptoms. The presence of a dominant ovarian follicle and pelvic congestion might also be related to endometriosis, although it's not directly diagnostic.
- Constipation or Irritable Bowel Syndrome (IBS): Although the CT shows normal bowel, functional bowel disorders can cause significant abdominal pain and should be considered, especially with non-specific pelvic exams and equivocal urinalysis results.
- Do Not Miss Diagnoses
- Ectopic Pregnancy: Despite a negative pregnancy test, very early ectopic pregnancies might not be detected by standard urine pregnancy tests. Given the patient's age and symptoms, it's crucial to rule out ectopic pregnancy, even if the test is negative, as it can be life-threatening.
- Ovarian Torsion: Although the transvaginal ultrasound shows no evidence of torsion, this condition can be intermittent and might not always be visible on imaging. It's a surgical emergency and should always be considered in the differential for acute pelvic pain.
- Appendicitis with Atypical Presentation: While the CT shows a normal appendix, atypical presentations of appendicitis, especially in females, can sometimes mimic other conditions. It's essential to keep this in mind, especially if the patient's condition worsens or if other symptoms develop.
- Rare Diagnoses
- Pelvic Neurogenic Tumors: These are rare tumors that could cause pelvic pain and might be associated with prominent lymph nodes if there's a malignant component.
- Chronic Pelvic Venous Disease: This condition involves the formation of ovarian and pelvic varices, which could cause chronic pelvic pain due to congestion, as suggested by the CT findings. However, it's less common and might require specific diagnostic tests for confirmation.