Differential Diagnosis for 38 yo Female with Lower Abdominal Pain

• Single most likely diagnosis
  • Lumbar disc herniation: The patient's symptoms of lower abdominal pain radiating into the right back, down to the buttocks, and into the foot, along with numbness in the right foot, are classic for a lumbar disc herniation, particularly at the L4-L5 or L5-S1 level. This condition compresses the nerve roots, leading to pain and numbness in the distribution of the affected nerve.
• Other Likely diagnoses
  • Musculoskeletal strain: Given the acute onset of pain and the distribution of symptoms, a musculoskeletal strain involving the lower back and gluteal muscles could be a plausible diagnosis. However, the presence of numbness in the foot might suggest a more specific nerve involvement.
  • Piriformis syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain, numbness, and tingling in the buttocks and down the leg. The symptoms could fit, but the abdominal pain component might be less typical.
• Do Not Miss diagnoses
  • Appendicitis: Although the patient denies urinary symptoms, appendicitis can sometimes present with atypical pain patterns, especially if the appendix is retrocecal. Missing this diagnosis could lead to severe consequences, including perforation and peritonitis.
  • Ovarian torsion: This is a surgical emergency that can present with severe, acute lower abdominal pain, sometimes radiating to the back. The absence of urinary symptoms does not rule out this condition, and missing it could lead to loss of the ovary.
  • Ectopic pregnancy: Given the patient's age and sex, an ectopic pregnancy must be considered, even though the patient does not mention menstrual irregularities or missed periods. This condition is life-threatening and requires immediate attention.
• Rare diagnoses
  • Tarlov cysts: These are rare, fluid-filled sacs that can compress nerve roots, leading to pain and neurological symptoms. They are less common and might not be the first consideration but could explain the patient's symptoms if other diagnoses are ruled out.
  • Cauda equina syndrome: This is a serious condition where the nerves in the spinal canal are compressed, leading to pain, numbness, and potentially bladder and bowel dysfunction. Although the patient denies urinary symptoms, this condition can sometimes present with atypical symptoms early on, making it a rare but critical diagnosis to consider.