Differential Diagnosis for Left Flank Pain Radiating to the Front Abdomen
Given the symptoms of left flank pain radiating to the front abdomen, with a normal CT scan and no kidney stones, the following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Musculoskeletal strain: This is often the most common cause of flank pain, especially if the pain is related to movement or posture and there's no other significant finding on the CT scan.
- Other Likely Diagnoses
- Diverticulitis: Although more common on the left side, diverticulitis can cause pain that might radiate from the back to the abdomen. The normal CT might not always rule this out, especially if the disease is mild.
- Gastrointestinal issues (e.g., constipation, gastroesophageal reflux disease): These can sometimes cause referred pain to the flank area.
- Herniated disk or spinal issues: These can cause radiating pain to the abdomen, depending on the nerve roots involved.
- Do Not Miss Diagnoses
- Aortic dissection or aneurysm: Although less common, these are life-threatening conditions that could present with severe back or flank pain radiating to the abdomen. A normal CT might not always capture these, especially if it's not specifically looked for.
- Pancreatitis: The pain from pancreatitis can radiate to the back and could be considered even with a normal CT, as the scan might not always show inflammation early on.
- Splenic infarct or rupture: These conditions can cause severe pain and might not always be evident on a CT scan, especially if the patient is not actively bleeding.
- Rare Diagnoses
- Retroperitoneal fibrosis: A rare condition that can cause abdominal and back pain due to the formation of fibrotic tissue in the retroperitoneum.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic pain, among other symptoms like hypertension.
- Neurogenic tumors: Tumors arising from the nerves can cause pain and might be located in the retroperitoneal space, potentially causing flank pain.
Each of these diagnoses should be considered in the context of the patient's full clinical picture, including history, physical examination, and laboratory findings, not just the CT scan results.