Differential Diagnosis for Right Flank Pain
Single Most Likely Diagnosis
- Musculoskeletal strain or costochondritis: The pain increases with deep breath, suggesting involvement of the musculoskeletal structures of the chest wall or the muscles in the flank area. This is a common cause of flank pain that worsens with movement or deep breathing.
Other Likely Diagnoses
- Pulmonary embolism (PE): Although less common, PE can cause flank pain, especially if the embolism is located in the lower lobes of the lung. The increase in pain with deep breaths could be due to the irritation of the pleura.
- Pneumonia: Right lower lobe pneumonia can cause right flank pain due to the proximity of the lung to the flank area. The pain worsening with deep breaths supports this possibility.
- Gastrointestinal issues (e.g., constipation, gastroesophageal reflux disease (GERD)): These conditions can sometimes refer pain to the flank area, though they are less likely given the absence of gastrointestinal symptoms.
Do Not Miss Diagnoses
- Pneumothorax: A spontaneous pneumothorax can cause sudden onset of sharp chest or flank pain that worsens with deep breathing. It's crucial to diagnose promptly due to the potential for the pneumothorax to become tensioned.
- Kidney infarction or renal vein thrombosis: Although the patient reports no urinary symptoms, these conditions can occasionally present with flank pain alone. They are critical to diagnose early due to the potential for severe kidney damage.
- Ovarian torsion (in females): This is a surgical emergency that can cause severe, acute flank pain. The absence of urinary symptoms does not rule out this diagnosis.
Rare Diagnoses
- Diaphragmatic rupture: A rare condition that can cause flank pain, especially if there is herniation of abdominal contents into the thoracic cavity.
- Retroperitoneal fibrosis: A rare condition characterized by the proliferation of fibrous tissue in the retroperitoneum, which can cause flank pain among other symptoms.
- Ehlers-Danlos syndrome or other connective tissue disorders: These can lead to various complications, including bowel or urinary tract issues, that might cause flank pain, though they are less common and typically associated with other systemic symptoms.