Right Flank Pain Differential Diagnosis

The differential diagnosis for right flank pain can be organized into the following categories:

• Single Most Likely Diagnosis

  • Nephrolithiasis (Kidney Stones): This is often the most common cause of acute flank pain, typically presenting with severe, colicky pain that may radiate to the groin. The pain is usually accompanied by nausea, vomiting, and sometimes hematuria.

• Other Likely Diagnoses

  • Pyelonephritis: An infection of the kidney, which can cause flank pain, fever, and other symptoms like dysuria and frequent urination.
  • Musculoskeletal Strain: Overuse or injury to the muscles in the flank area can cause pain, especially if there's a history of heavy lifting or strenuous activity.
  • Herniated Disk: A herniated disk in the lower back can cause radiating pain to the flank area, especially if the disk is compressing a nerve root that supplies the area.

• Do Not Miss Diagnoses

  • Appendicitis (if the appendix is retrocecal): Although appendicitis typically presents with right lower quadrant pain, a retrocecal appendix can cause pain that is perceived in the flank.
  • Pulmonary Embolism: In rare cases, a pulmonary embolism can cause referred pain to the flank area, especially if the embolism is large and affects the upper parts of the lung.
  • Aortic Dissection or Aneurysm: These are life-threatening conditions that can cause severe, tearing pain that may be perceived in the flank, back, or abdomen.

• Rare Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, sweating, palpitations, and flank pain.
  • Renal Cell Carcinoma: A type of kidney cancer that may cause flank pain, hematuria, and a palpable mass, though it often presents asymptomatically until late stages.
  • Epididymitis or Orchitis: Inflammation of the epididymis or testis, which can cause pain that may radiate to the flank area, especially if the condition is severe or involves the right side.