Differential Diagnosis for Solar Plexus Pain

When considering the causes of solar plexus pain, especially when palpated or during stretching, it's crucial to approach the diagnosis systematically. The solar plexus, or celiac plexus, is a complex network of nerves located in the upper abdomen, and pain in this area can be referred from various organs or be due to direct irritation of the nerves. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, which can cause pain in the upper abdomen, including the solar plexus area, especially after eating or when lying down.
• Other Likely Diagnoses
  • Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause pain that may be referred to the solar plexus area, often described as burning or gnawing.
  • Gastritis: Inflammation of the stomach lining can lead to upper abdominal pain, including the solar plexus area, and is often associated with nausea and vomiting.
  • Pancreatitis: Inflammation of the pancreas, which can be acute or chronic, often causes severe upper abdominal pain that may radiate to the back.
  • Cholecystitis: Inflammation of the gallbladder, usually due to gallstones, can cause right upper quadrant pain that may also be felt in the solar plexus area.
• Do Not Miss Diagnoses
  • Myocardial Infarction: Although less common, cardiac conditions like myocardial infarction (heart attack) can present with atypical symptoms, including upper abdominal pain that might be mistaken for solar plexus pain.
  • Pulmonary Embolism: A blockage in one of the pulmonary arteries can cause sudden, severe chest pain that may also be felt in the upper abdomen.
  • Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that may radiate to the abdomen.
• Rare Diagnoses
  • Celiac Plexus Neuroma or Neuritis: A tumor or inflammation of the nerves in the solar plexus can cause chronic pain in the area.
  • Splanchnic Nerve Entrapment: Entrapment of the nerves that innervate abdominal organs can cause chronic abdominal pain, including in the solar plexus area.
  • Abdominal Wall Pain: Conditions affecting the abdominal wall, such as rectus sheath hematoma or abdominal wall hernias, can cause localized pain that might be confused with solar plexus pain.

Each of these diagnoses has a unique set of accompanying symptoms and risk factors that can help guide the diagnostic process. A thorough history, physical examination, and appropriate diagnostic tests are essential for determining the underlying cause of solar plexus pain.