Differential Diagnosis for Left Upper Quadrant Pain Radiating to the Back
- Single Most Likely Diagnosis
- Pancreatitis: The pain radiating to the back and lack of relief are classic symptoms for pancreatitis, especially if the pain is constant and not necessarily related to eating or bowel movements. The absence of tenderness on pulsation makes a vascular cause less likely, pointing more towards an inflammatory or enzymatic issue like pancreatitis.
- Other Likely Diagnoses
- Peptic Ulcer Disease (PUD): Although PUD typically presents with epigastric pain, it can sometimes radiate to the back. The pain is often related to eating and can be relieved by antacids or food, but in severe cases, it might not provide relief.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest and upper abdominal pain that might radiate to the back. However, the pain is usually related to eating or lying down and can be relieved by antacids.
- Splenic Infarction or Rupture: These conditions can cause severe left upper quadrant pain radiating to the back. However, they are typically associated with specific risk factors (e.g., trauma, sickle cell disease) and might present with tenderness on palpation.
- Do Not Miss Diagnoses
- Aortic Dissection: Although the pain is not typically described as tender on pulsation, aortic dissection is a life-threatening condition that can present with severe back pain radiating from the chest or upper abdomen. It's crucial to consider this diagnosis, especially in patients with risk factors like hypertension or aortic aneurysm.
- Pulmonary Embolism: While less common, a pulmonary embolism can cause referred pain to the upper back. This diagnosis is critical to consider, especially in patients with risk factors for deep vein thrombosis or pulmonary embolism.
- Rare Diagnoses
- Diabetic Radiculopathy: This condition can cause severe back pain that might radiate from the upper abdomen. However, it's typically associated with diabetes and might have other neurological symptoms.
- Retroperitoneal Hemorrhage or Abscess: These conditions can cause severe back and abdominal pain. They are often associated with specific risk factors (e.g., anticoagulation, recent surgery) and might present with other symptoms like fever or signs of shock.