Differential Diagnosis for Left Sided Pelvic Pain
- The patient's symptoms of left sided pelvic pain during ovulation and periods, ongoing for 3 years, with a normal Transvaginal Ultrasound (TVUS), can be approached by considering the following categories:
Single Most Likely Diagnosis
- Endometriosis: This condition is a common cause of cyclic pelvic pain, especially if it's related to ovulation and menstruation. The fact that the pain is localized to one side suggests that endometriosis might be affecting the left ovary or fallopian tube. Endometriosis can cause pain even with a normal TVUS, as it may not always be visible on ultrasound.
Other Likely Diagnoses
- Ovarian Cysts: Although the TVUS is normal, cysts can form and resolve quickly, potentially causing intermittent pain. The pain during ovulation could be related to ovulatory cysts or ruptured cysts.
- Adenitis or Salpingitis: Inflammation of the fallopian tubes or surrounding tissues can cause pelvic pain, especially if it's related to menstrual cycles. This could be due to infectious or non-infectious causes.
- Irritable Bowel Syndrome (IBS): IBS can cause pelvic pain that may worsen during menstruation due to hormonal changes affecting bowel habits. The pain can be localized to one side.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although less likely given the patient's history of regular periods and the absence of other symptoms like missed periods or positive pregnancy tests, any possibility of ectopic pregnancy is a medical emergency and must be ruled out, especially if there's a sudden increase in pain.
- Ovarian Torsion: This is another emergency that can cause severe, sudden pelvic pain. It's less likely given the chronic nature of the patient's symptoms, but it should be considered if the pain suddenly worsens.
- Appendicitis: Although appendicitis typically presents with right lower quadrant pain, it can occasionally cause left lower quadrant pain if the appendix is retrocecal and extends to the left. This is a surgical emergency.
Rare Diagnoses
- Congenital Anomalies of the Reproductive Tract: Rare anomalies like a unicornuate uterus or rudimentary horn can cause localized pain, especially if there's an associated endometriosis or obstruction.
- Pelvic Inflammatory Disease (PID) due to Unusual Pathogens: PID is typically associated with sexually transmitted infections, but rare cases can be caused by other pathogens, leading to chronic inflammation and pain.
- Chronic Pelvic Pain Syndromes: These are complex conditions that may involve multiple factors, including neurological, muscular, and psychological components, leading to chronic pain.