Differential Diagnosis for Pain in Rib Area in a 32 Week Pregnant Female with UTI

• Single Most Likely Diagnosis
  • Pyelonephritis: This is a likely diagnosis given the patient's UTI and pregnancy status. Pyelonephritis, an infection of the kidney, can cause flank or rib area pain, and pregnancy increases the risk of developing this condition due to urinary stasis and ureteral dilation.
• Other Likely Diagnoses
  • Costochondritis: This condition, which involves inflammation of the cartilage that connects the ribs to the breastbone, can cause rib area pain and is common in pregnancy due to the stretching of the chest wall.
  • Rib fracture: Although less common, rib fractures can occur in pregnancy, especially if there has been trauma. The pain would be localized to the area of the fracture.
  • Musculoskeletal strain: The growing uterus can cause musculoskeletal strain, leading to pain in the rib area due to the stretching and pulling of muscles and ligaments.
• Do Not Miss Diagnoses
  • Pulmonary embolism: Although less likely, pulmonary embolism is a potentially life-threatening condition that can cause sudden onset of chest or rib area pain, especially in pregnant women who are at increased risk due to hypercoagulability.
  • Placental abruption: This condition, where the placenta separates from the uterus, can cause severe abdominal pain that may radiate to the rib area and is a medical emergency.
  • Pneumonia: Infection in the lungs can cause rib area pain and is important to diagnose and treat promptly, especially in pregnant women who may be more susceptible to severe respiratory infections.
• Rare Diagnoses
  • Sickle cell crisis: In patients with sickle cell disease, a crisis can cause severe pain, including in the rib area, due to vaso-occlusion.
  • Osteonecrosis: Although rare, osteonecrosis (death of bone tissue) can occur in pregnancy, potentially causing rib area pain, especially if there is a history of steroid use or other risk factors.