Differential Diagnosis for Pain Radiating to R Hip, R Rib Cage, and R Side of Groin

Single Most Likely Diagnosis

• Nephrolithiasis (Kidney Stones): Pain radiating to the groin, hip, and possibly the rib cage can be indicative of a kidney stone, especially if the pain is severe and colicky. The pain pattern is consistent with the path a stone might take as it moves down the ureter.

Other Likely Diagnoses

• Musculoskeletal Strain or Injury: Strains or injuries to the muscles or ligaments in the lower back, hip, or groin area can cause pain that radiates to these regions.
• Herniated Disk or Lumbar Radiculopathy: A herniated disk in the lumbar spine can cause pain that radiates down to the hip and groin due to nerve compression.
• Appendicitis (if pain started near the navel and then moved): While the classic presentation of appendicitis involves pain starting near the navel and then moving to the lower right abdomen, some cases can present with pain radiating to the groin or hip.

Do Not Miss Diagnoses

• Abdominal Aortic Aneurysm (AAA): Although less common, an AAA can cause severe, radiating pain to the back, hip, and groin, especially if it is expanding or rupturing. This is a medical emergency.
• Ectopic Pregnancy: In women, an ectopic pregnancy can cause severe, sharp pain that can radiate to the groin, hip, and possibly the rib cage, depending on the location and extent of the ectopic pregnancy.
• Pulmonary Embolism: While less typical, a pulmonary embolism can cause chest pain that radiates to the back and possibly the hip or groin if the embolism is large and affects blood flow significantly.

Rare Diagnoses

• Psoas Abscess: An abscess in the psoas muscle can cause pain that radiates from the lower back down to the hip and groin.
• Ovarian Torsion: In women, ovarian torsion can cause severe, sharp pain that can radiate to the groin, hip, and possibly the lower back.
• Retroperitoneal Hemorrhage: Bleeding into the space behind the peritoneum (retroperitoneal space) can cause pain that radiates to the back, hip, and groin, depending on the location and extent of the hemorrhage.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and potentially, diagnostic imaging or laboratory tests to confirm the diagnosis.