Differential Diagnosis for 61yo Female with Left Lower Back Pain and Radiation to Upper Abdominal Area
Single Most Likely Diagnosis
- Pyelonephritis or Kidney Infection: Given the patient's symptoms of left lower back pain radiating to the upper abdominal area and a possible positive urine analysis (UA) test, pyelonephritis is a strong consideration. The radiation of pain to the upper abdominal area can be consistent with the referral pattern of renal pain.
Other Likely Diagnoses
- Nephrolithiasis (Kidney Stones): Pain from kidney stones can radiate from the flank to the abdomen and is often associated with urinary symptoms. A positive UA could indicate the presence of stones or an infection.
- Musculoskeletal Strain: Given the age of the patient, musculoskeletal strain could be a cause of her back pain, although the radiation to the upper abdominal area might be less typical.
- Diverticulitis: Although more commonly associated with left lower quadrant abdominal pain, diverticulitis could potentially cause back pain if the inflammatory process involves adjacent structures.
Do Not Miss Diagnoses
- Abdominal Aortic Aneurysm (AAA): Although less common in women, an AAA can present with back pain and abdominal pain. Given the potential for catastrophic outcomes if missed, it's crucial to consider this diagnosis, especially in older adults.
- Pancreatitis: Acute pancreatitis can cause severe back pain radiating to the abdomen. The absence of fever does not rule out this diagnosis, and it's critical to consider due to its potential severity.
- Pulmonary Embolism: While less likely given the description, pulmonary embolism can cause back pain and should be considered, especially if there are any respiratory symptoms or risk factors for thromboembolism.
Rare Diagnoses
- Spinal Tumors or Metastases: Tumors in the spine can cause back pain, and while rare, they should be considered, especially in older adults with a new onset of back pain.
- Retroperitoneal Fibrosis: A rare condition that can cause back pain and abdominal pain due to the formation of fibrotic tissue in the retroperitoneum.
- Inflammatory Arthropathies (e.g., Ankylosing Spondylitis): Although more common in younger populations, these conditions can cause back pain and should be considered if other symptoms or risk factors are present.