Differential Diagnosis for 78 yo male with Right Lower Back Pain Radiating to Right Hip
Single Most Likely Diagnosis
- Lumbar Radiculopathy: Given the patient's complaint of right lower back pain radiating to the right hip and a history of lumbar radiculopathy, this condition is the most likely cause. The pain pattern is consistent with nerve root irritation, which is a hallmark of radiculopathy.
Other Likely Diagnoses
- Musculoskeletal Strain: The patient's age and the nature of the pain could suggest a musculoskeletal strain, especially if there was a recent increase in activity or a specific incident that triggered the pain.
- Degenerative Joint Disease: Osteoarthritis of the hip or lumbar spine could cause pain radiating from the lower back to the hip, especially in an elderly patient.
- Polyneuropathy: Although the patient has a history of polyneuropathy, which typically presents with bilateral symptoms, it's possible that the neuropathy could be asymmetric, contributing to the patient's pain.
Do Not Miss Diagnoses
- Spinal Epidural Abscess: Although less likely, this is a potentially deadly condition that requires immediate attention. The patient's history of HIV increases the risk of infections, including spinal epidural abscess.
- Cauda Equina Syndrome: A serious condition that requires urgent intervention, characterized by low back pain, bilateral sciatica, and potentially bladder and bowel dysfunction.
- Pathological Fracture: Given the patient's age and potential for osteoporosis, a pathological fracture should be considered, especially if there's a history of cancer or significant trauma.
Rare Diagnoses
- Diabetic Amyotrophy: Although the patient's history does not mention diabetes, this condition can cause severe pain, usually in the front of the thigh, but could potentially radiate to the hip.
- Piriformis Syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, causing pain in the buttocks and hip.
- Intra-abdominal or Pelvic Pathology: Conditions such as appendicitis, diverticulitis, or an intra-abdominal shunt infection (in the context of CKD and potential dialysis) could refer pain to the lower back and hip area, although these would typically be accompanied by other systemic symptoms.