Differential Diagnosis for Right Upper Quadrant Pain

Given the patient's presentation and the results of the diagnostic tests, the following differential diagnoses can be considered:

• Single Most Likely Diagnosis

  • Musculoskeletal pain referred from the thoracic spine: The patient's thoracic x-ray showing mild kyphosis, burning of the mid thoracic spine, and mild dextroscoliosis could be causing referred pain to the right upper quadrant. This is a common phenomenon where pain from the spine is referred to the abdominal region due to shared nerve roots.

• Other Likely Diagnoses

  • Peptic ulcer disease: Although GI scans have been done, peptic ulcer disease can sometimes be missed, especially if the ulcers are small or located in areas difficult to visualize.
  • Pancreatitis: Mild cases or those not causing significant pancreatic enlargement might not be evident on initial scans, and the pain can sometimes be referred to the right upper quadrant.
  • Hepatic or biliary pathology not detected by initial scans: There could be conditions affecting the liver or biliary system that were not identified by the CT, HIDA, or ultrasound scans, such as small stones, biliary dyskinesia, or early stages of liver disease.

• Do Not Miss Diagnoses

  • Pulmonary embolism: Although less likely given the preserved disk spaces and the focus on abdominal pain, pulmonary embolism can cause sudden onset of pain that might be referred to the abdomen, especially if there's associated pleuritic chest pain.
  • Aortic dissection: This is a life-threatening condition that can cause severe, tearing pain often radiating to the back but can also be referred to the abdomen.
  • Pneumonia: Certain types of pneumonia, especially those involving the right lower lobe, can cause referred pain to the right upper quadrant due to diaphragmatic irritation.

• Rare Diagnoses

  • Diaphragmatic irritation or rupture: Conditions affecting the diaphragm, such as a rupture or significant irritation, can cause abdominal pain referred from the thoracic region.
  • Thoracic spine fracture or osteomyelitis: Although the x-ray showed some abnormalities, more severe conditions like fractures or infections of the thoracic spine could cause significant pain that might be referred to the abdomen.
  • Referred pain from other thoracic conditions: Other rare conditions affecting the thorax, such as esophageal spasm or thoracic duct cysts, could potentially cause referred pain to the right upper quadrant.