Differential Diagnosis for 61 yo Male with Right Side Flank Pain
Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stones): Given the patient's history of passing kidney stones and the current complaint of flank pain, which is a common symptom of kidney stones, this diagnosis is highly probable. The patient's past experience with lithotripsy, a procedure used to break up stones, further supports this likelihood.
Other Likely Diagnoses
- Pyelonephritis: An infection of the kidney, which could cause flank pain. The patient's history of kidney stones increases the risk of developing pyelonephritis.
- Musculoskeletal Strain: Given the location of the pain, it could also be related to muscle strain in the flank area, although this is less likely given the patient's history of kidney issues.
- Renal Colic: Similar to nephrolithiasis, but more specifically refers to the severe pain associated with the passage of a kidney stone.
Do Not Miss Diagnoses
- Appendicitis: Although less common on the right flank, appendicitis can sometimes present with pain in this area, especially if the appendix is located in a retrocecal position. Missing this diagnosis could lead to severe consequences, including perforation and peritonitis.
- Diverticulitis: Inflammation of a diverticulum in the colon, which can cause severe pain, often on the left side but can be on the right if the diverticula are located there. It's a condition that requires prompt treatment to avoid complications.
- Pulmonary Embolism: Can cause sudden onset of flank pain if the embolism affects the pulmonary vessels near the diaphragm, though this would typically be accompanied by respiratory symptoms.
- Aortic Aneurysm or Dissection: A life-threatening condition that could present with sudden, severe flank or back pain. It's crucial to consider this diagnosis, especially in older patients.
Rare Diagnoses
- Renal Cell Carcinoma: A type of kidney cancer that could cause flank pain, although it would typically be accompanied by other symptoms such as hematuria (blood in the urine) or a palpable mass.
- Polycystic Kidney Disease (PKD): A genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys, which can cause flank pain. However, this would typically be diagnosed earlier in life or have a family history.
- Renal Infarction: A condition where the blood supply to the kidney is interrupted, causing tissue death. It's rare but can cause severe flank pain and would require immediate medical attention.