Differential Diagnosis for Sudden Severe Right CVA Tenderness in Pregnancy
Given the scenario of a pregnant individual taking Tylenol daily for headaches and presenting with sudden severe right costovertebral angle (CVA) tenderness, with normal cervical length, urinalysis (UA), and retroperitoneal ultrasound, the following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Pyelonephritis: Despite the normal urinalysis, pyelonephritis cannot be ruled out entirely, especially if the UA was done recently and the infection is early or localized. The severe CVA tenderness is a classic symptom, and pregnancy increases the risk of urinary tract infections progressing to pyelonephritis.
- Other Likely Diagnoses
- Kidney Stone (Nephrolithiasis): The sudden onset of severe CVA tenderness is consistent with a kidney stone, which can cause significant pain. Pregnancy increases the risk of stone formation due to urinary stasis and other metabolic changes.
- Musculoskeletal Pain: Given the patient's history of headaches and daily Tylenol use, musculoskeletal pain, possibly related to muscle strain or overuse, could be a consideration, especially if there are no other systemic symptoms.
- Do Not Miss Diagnoses
- Appendicitis: Although the pain is localized to the CVA, appendicitis can sometimes present with atypical pain patterns, especially in pregnancy when the appendix may be displaced. Missing appendicitis can lead to severe consequences, including perforation and peritonitis.
- Ovarian Torsion: This is a surgical emergency that can present with sudden, severe pain. Although less common, it is crucial not to miss this diagnosis due to its potential for significant morbidity if not promptly treated.
- Ectopic Pregnancy: Although the scenario does not strongly suggest ectopic pregnancy, any severe abdominal or pelvic pain in early pregnancy should prompt consideration of this diagnosis, given its potential lethality if missed.
- Rare Diagnoses
- Renal Infarction: This is a rare condition that could present with acute flank pain. It is more common in patients with certain risk factors such as atrial fibrillation or hypercoagulable states.
- Retroperitoneal Hematoma: Although the retroperitoneal ultrasound was normal, a small or evolving hematoma might not be immediately visible. This could be a consideration, especially if there's a history of trauma or anticoagulation.