Differential Diagnosis
- Single most likely diagnosis
- Renal tumor with possible local spread or metastasis: This diagnosis is most likely given the patient's known history of a right renal lesion, recent diagnosis of kidney cancer, and scheduled partial nephrectomy. The sharp, constant pain radiating to her back and the presence of a lump in her lower right abdomen are consistent with a growing tumor.
- Other Likely diagnoses
- Musculoskeletal pain: Given the patient's description of sharp, constant pain that worsens with activity, musculoskeletal pain is a possible diagnosis. However, the presence of a lump and radiation to her back makes this less likely.
- Nephrolithiasis: Kidney stones could cause severe pain radiating to the back, but the patient's history and recent imaging studies make this less likely.
- Pyelonephritis or other urinary tract infections: Although the patient has a history of kidney issues, there is no mention of fever, dysuria, or other symptoms typical of a urinary tract infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Metastatic disease: Given the patient's history of kidney cancer, the possibility of metastatic disease should be considered, especially with the new complaint of a lump in her lower right abdomen.
- Retroperitoneal hemorrhage: Although less likely, a retroperitoneal hemorrhage could cause severe pain and a palpable mass, and would be a medical emergency.
- Abdominal aortic aneurysm: This is a less likely diagnosis, but would be life-threatening if missed. The patient's age and history of kidney disease make this a possibility.
- Rare diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that could cause abdominal pain and a palpable mass.
- Retroperitoneal fibrosis: A rare condition that could cause abdominal pain and a palpable mass, although it is less likely given the patient's history and recent imaging studies.
- Abdominal lymphoma: Although the patient had recent lymph node swelling, this was determined to be normal. However, abdominal lymphoma is a rare possibility that should be considered.