Differential Diagnosis for Abdominal Pain Radiating to Scapula
- Single most likely diagnosis
- Peptic ulcer disease (PUD): The classic description of upper abdominal pain radiating to the scapula is often associated with PUD, particularly duodenal ulcers. This pain pattern is due to the irritation of the diaphragm by the ulcer, which shares a nerve root with the scapula.
- Other Likely diagnoses
- Cholecystitis: Inflammation of the gallbladder can cause upper abdominal pain that may radiate to the right scapula, especially if a stone is impacted in the cystic duct.
- Pancreatitis: Both acute and chronic pancreatitis can cause upper abdominal pain that radiates to the back, including the scapular area, due to the retroperitoneal location of the pancreas.
- Esophageal disorders (e.g., esophagitis, esophageal spasm): These conditions can cause chest or upper abdominal pain that may radiate to the back or scapula.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial infarction (MI): Although less common in women, especially at this age, MI can present with atypical symptoms, including upper abdominal pain or discomfort radiating to the back.
- Aortic dissection: This is a life-threatening condition that can cause severe, tearing chest or back pain, which may radiate to the abdomen or scapula.
- Pulmonary embolism (PE): While PE typically presents with respiratory symptoms, it can occasionally cause chest or upper abdominal pain that radiates to the back.
- Rare diagnoses
- Diaphragmatic irritation from other causes (e.g., pneumonia, pleuritis): These conditions can cause upper abdominal or chest pain that radiates to the scapula due to diaphragmatic irritation.
- Thoracic spine disorders (e.g., herniated disk, osteoporotic fracture): These conditions can cause back pain that radiates to the abdomen or scapula, although this would be less common.