Differential Diagnosis for a 32-year-old Male with Abdominal Pain and a Solitary Mesenteric Lymph Node
- Single most likely diagnosis:
- Mesenteric lymphadenitis: This condition, often caused by viral or bacterial infections, can lead to abdominal pain and the enlargement of mesenteric lymph nodes. The presence of a solitary mesenteric lymph node and abdominal pain makes this a plausible diagnosis.
- Other Likely diagnoses:
- Gastrointestinal malignancy (e.g., lymphoma): Although less common in younger individuals, lymphoma can present with abdominal pain and lymphadenopathy, including solitary mesenteric lymph nodes.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease can cause abdominal pain, mesenteric lymphadenopathy, and may also lead to complications that could explain the moderate lobulation of the kidney (e.g., amyloidosis in chronic disease).
- Diverticulitis or other gastrointestinal infections: These conditions can cause abdominal pain and may be associated with mesenteric lymphadenopathy.
- Do Not Miss diagnoses:
- Testicular cancer with retroperitoneal metastasis: Although testicular cancer primarily metastasizes to retroperitoneal lymph nodes, it's crucial not to miss this diagnosis due to its high curability if caught early.
- Abdominal aortic aneurysm or other vascular emergencies: These conditions can cause abdominal pain and might be associated with changes in nearby structures, including lymph nodes, due to inflammation or compression.
- Kidney disease (e.g., polycystic kidney disease): The mention of moderate lobulation of the kidney suggests underlying kidney pathology, which could be related to the abdominal pain and potentially to the lymphadenopathy if there's associated infection or malignancy.
- Rare diagnoses:
- Castleman disease: A rare disorder that involves an overgrowth of cells in the lymphatic system, which could explain the solitary mesenteric lymph node.
- Sarcoidosis: Although more commonly associated with pulmonary symptoms, sarcoidosis can cause lymphadenopathy and might involve abdominal organs, leading to pain.
- Whipple's disease: A rare, systemic bacterial infection that can cause abdominal pain, weight loss, and lymphadenopathy, among other symptoms.