Differential Diagnosis for RUQ Pain Radiating to Back

• Single Most Likely Diagnosis
  • Cholecystitis: Inflammation of the gallbladder is a common cause of right upper quadrant (RUQ) pain that can radiate to the back, especially if a stone is obstructing the cystic duct. The pain is often exacerbated by fatty meals and can be accompanied by nausea and vomiting.
• Other Likely Diagnoses
  • Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause epigastric pain that radiates to the back. The pain is typically worsened by food and improved by antacids.
  • Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that radiates to the back, often accompanied by nausea, vomiting, and elevated pancreatic enzymes.
  • Hepatitis: Inflammation of the liver can cause RUQ pain that may radiate to the back, along with jaundice, fatigue, and elevated liver enzymes.
• Do Not Miss Diagnoses
  • Myocardial Infarction: Although less common, myocardial infarction (heart attack) can present with atypical symptoms, including RUQ or back pain, especially in women or diabetic patients.
  • Aortic Dissection: A tear in the aorta can cause severe, tearing chest or back pain that radiates to the abdomen, which is a medical emergency.
  • Pulmonary Embolism: A blood clot in the lungs can cause sudden onset of chest pain or back pain, often accompanied by shortness of breath and tachycardia.
• Rare Diagnoses
  • Boerhaave's Syndrome: A rare condition where there is a spontaneous rupture of the esophagus, leading to severe chest or back pain, often accompanied by difficulty swallowing and vomiting.
  • Fitz-Hugh-Curtis Syndrome: A rare condition where there is inflammation of the liver capsule and adjacent peritoneal surfaces, often due to pelvic inflammatory disease, causing RUQ pain that radiates to the right shoulder or back.