Differential Diagnosis for 50-year-old Patient with HIV, Hypertension, and Left Back/Iliac Pain Radiating to Lower Central Abdomen
Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stones): Given the patient's presentation of left back/iliac pain radiating to the lower central abdomen, nephrolithiasis is a common condition that could cause such symptoms, especially if the stone is obstructing the ureter and causing renal colic.
Other Likely Diagnoses
- Pyelonephritis: An infection of the kidney, which could be more likely in a patient with HIV due to their immunocompromised state. Symptoms can include flank pain, fever, and abdominal pain.
- Hypertensive Nephrosclerosis: Given the patient's history of hypertension, chronic high blood pressure could be causing damage to the kidneys, leading to pain and potentially other symptoms like hematuria or proteinuria.
- Musculoskeletal Strain: The pain could be due to a musculoskeletal issue, such as a strain in the back or abdominal muscles, which is relatively common and can sometimes radiate or refer pain to other areas.
Do Not Miss Diagnoses
- Abdominal Aortic Aneurysm (AAA): Although less common, an AAA can present with back or abdominal pain and is a medical emergency. The patient's history of hypertension increases the risk of AAA.
- Retroperitoneal Hemorrhage: Bleeding into the space behind the peritoneum can cause severe back and abdominal pain. This could be due to various causes, including anticoagulation (if the patient is on such therapy), trauma, or vascular abnormalities.
- Pulmonary Embolism: While the primary symptoms might not directly suggest a pulmonary embolism, it's a condition that can sometimes present atypically, especially in patients with HIV who may have a higher risk of thromboembolic events.
Rare Diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension and pain due to catecholamine release. The pain can sometimes be referred to the back or abdomen.
- Primary or Metastatic Tumors: Tumors affecting the kidney, adrenal glands, or surrounding structures could cause the patient's symptoms. Given the patient's HIV status, there might be an increased risk of certain malignancies.
- Inflammatory or Infectious Processes: Conditions like pancreatitis, diverticulitis, or an infected cyst could cause the patient's symptoms, though they might be less likely given the specific description of pain.