Differential Diagnosis for Right Flank Pain in a 70-year-old Woman

• Single Most Likely Diagnosis

  • Nephrolithiasis (Kidney Stones): This is a common cause of flank pain, especially in older adults. The pain is often severe and can radiate to the groin. The patient's age and the location of the pain make this a likely diagnosis.

• Other Likely Diagnoses

  • Pyelonephritis (Kidney Infection): This is an infection of the kidney that can cause flank pain, fever, and other symptoms. Older adults are more susceptible to urinary tract infections, which can ascend to the kidneys.
  • Musculoskeletal Strain: Given the patient's age, a musculoskeletal strain or injury could be a cause of flank pain, especially if there has been recent physical activity or trauma.
  • Degenerative Disc Disease or Herniated Disc: Spinal issues can refer pain to the flank area, and older adults are more prone to spinal degeneration.

• Do Not Miss Diagnoses

  • Renal Cell Carcinoma (Kidney Cancer): Although less common, kidney cancer can present with flank pain and is more likely in older adults. Early detection is crucial for treatment.
  • Pulmonary Embolism: While less common as a cause of flank pain, a pulmonary embolism can refer pain to the flank area, especially if the embolism is located in the upper lobes of the lungs. This is a life-threatening condition that requires immediate attention.
  • Aortic Aneurysm or Aortic Dissection: These are life-threatening vascular emergencies that can cause severe flank or back pain. Although less common, they are critical to diagnose promptly.

• Rare Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, sweating, and flank pain.
  • Retroperitoneal Fibrosis: A rare condition characterized by the proliferation of fibrous tissue in the retroperitoneum, which can cause flank pain and obstructive uropathy.
  • Eosinophilic Granuloma (Langerhans Cell Histiocytosis): A rare disorder that can affect various parts of the body, including the bones, and cause flank pain if the kidneys or surrounding structures are involved.