Differential Diagnosis for Chronic Left-Sided Pelvic Pain
- Single Most Likely Diagnosis
- Endometriosis: This condition is characterized by the presence of endometrial tissue outside the uterus, leading to chronic pelvic pain, dysmenorrhea, and dyspareunia. The patient's symptoms of intermittent, severe left-sided pelvic pain during ovulation and menstruation, along with pain during sexual intercourse, are consistent with endometriosis. The normal TVUS does not rule out this diagnosis, as endometriosis can be difficult to detect with imaging alone.
- Other Likely Diagnoses
- Ovarian cysts: Although the TVUS was normal, ovarian cysts can be intermittent and may not always be visible on ultrasound. The patient's symptoms of pelvic pain during ovulation and menstruation could be related to ovarian cysts.
- Pelvic adhesions: Adhesions in the pelvic cavity can cause chronic pain, especially if they involve the left ovary or fallopian tube. The patient's history of chronic pain and dyspareunia suggests the possibility of adhesions.
- Irritable bowel syndrome (IBS): IBS can cause chronic pelvic pain, bloating, and changes in bowel habits. Although the patient does not report gastrointestinal symptoms, IBS can sometimes present with pelvic pain as the primary symptom.
- Do Not Miss Diagnoses
- Ectopic pregnancy: Although the patient denies unprotected sexual activity, it is essential to consider ectopic pregnancy as a possible cause of pelvic pain, especially if there is any chance of pregnancy. Ectopic pregnancy can be life-threatening if not promptly diagnosed and treated.
- Ovarian torsion: Ovarian torsion is a surgical emergency that can cause severe pelvic pain. Although the patient's pain is chronic, it is essential to consider this diagnosis, especially if the pain suddenly worsens.
- Appendicitis: Appendicitis can cause pelvic pain, especially if the appendix is located in the pelvic cavity. Although the patient does not report typical symptoms of appendicitis, such as fever or vomiting, it is essential to consider this diagnosis.
- Rare Diagnoses
- Chronic pelvic inflammatory disease (PID): PID can cause chronic pelvic pain, especially if it is not adequately treated. Although the patient does not report any history of PID or sexually transmitted infections, it is essential to consider this diagnosis.
- Uterine fibroids: Fibroids can cause chronic pelvic pain, especially if they are large or numerous. Although the TVUS was normal, fibroids can sometimes be missed on ultrasound.
- Pelvic congestion syndrome: This condition is characterized by chronic pelvic pain due to varicose veins in the pelvic cavity. It is a rare diagnosis, but it should be considered in patients with chronic pelvic pain, especially if other diagnoses have been ruled out.