Differential Diagnosis for Severe Mid Back Pain
The patient presents with severe bilateral mid back pain radiating to the lower back, which started after experiencing cold symptoms. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Musculoskeletal strain: This is the most likely diagnosis given the sudden onset of severe back pain after a viral illness, which can weaken the muscles and make them more susceptible to strain.
- Other Likely diagnoses
- Pneumonia: The initial cold symptoms could have progressed to pneumonia, which can cause mid back pain due to the involvement of the lungs and pleura.
- Pulmonary embolism: Although less common, pulmonary embolism can present with sudden onset back pain, especially if the embolism is located in the upper lobes of the lungs.
- Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum can cause mid back pain, especially if the patient has been coughing due to the initial cold symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe back pain that can radiate to the lower back.
- Spinal epidural abscess: A rare but potentially deadly condition where an abscess forms in the spinal canal, causing severe back pain, fever, and neurological symptoms.
- Pneumothorax: A collapsed lung can cause sudden onset back pain, especially if the patient has been coughing or has underlying lung disease.
- Rare diagnoses
- Osteomyelitis: A bone infection that can cause severe back pain, although it is less common and usually associated with other symptoms like fever and localized redness.
- Spinal tumor: A tumor in the spine can cause back pain, although it is rare and usually associated with other symptoms like neurological deficits and weight loss.
- Sickle cell crisis: Patients with sickle cell disease can experience severe back pain due to vaso-occlusive crises, although this is rare and usually associated with other symptoms like fever and anemia.