Differential Diagnosis for Chest Pain and Low Back Pain Radiating to Scrotum with Hypotension
Single Most Likely Diagnosis
- Aortic Dissection: This condition is highly likely given the combination of chest pain, low back pain radiating to the scrotum, and hypotension. The pain pattern is classic for aortic dissection, which can cause severe, tearing pain that radiates down the back and into the groin or scrotum. Hypotension can occur due to impaired cardiac output or bleeding.
Other Likely Diagnoses
- Pulmonary Embolism: Although less likely to cause radiating pain to the scrotum, a large pulmonary embolism can cause chest pain and hypotension. The low back pain could be referred pain or due to another concurrent condition.
- Myocardial Infarction: An MI can cause chest pain and hypotension, especially if it's an extensive infarct affecting the heart's pumping ability. However, the radiation of pain to the scrotum is less typical.
- Ureteral Colic: While typically causing severe flank pain, in some cases, the pain from a kidney stone can radiate to the groin or scrotum. However, it would be unusual for ureteral colic to cause hypotension unless there's associated severe pain leading to a stress response or an underlying condition like sepsis.
Do Not Miss Diagnoses
- Ruptured Abdominal Aortic Aneurysm (AAA): This is a life-threatening condition that can present with abdominal or back pain radiating to the groin, along with hypotension due to blood loss. It's crucial not to miss this diagnosis.
- Cardiac Tamponade: Although the pain pattern might not perfectly match, cardiac tamponade can cause hypotension and chest pain. It's a condition that requires immediate recognition and treatment.
- Sepsis: Sepsis can cause hypotension and diffuse pain, including back pain. While the radiation to the scrotum might not be directly explained, sepsis is a condition that must be considered, especially if there's a suspected source of infection.
Rare Diagnoses
- Testicular Torsion: While this condition causes severe testicular pain, it's less likely to cause the combination of chest pain, low back pain, and hypotension unless there's a significant systemic response.
- Epididymitis or Orchitis: These conditions can cause scrotal pain but are unlikely to cause the full spectrum of symptoms described, including chest pain and hypotension, unless complicated by a systemic infection.
- Spinal Epidural Abscess: This rare condition can cause back pain and, if the abscess compresses the spinal cord, can lead to hypotension and radiating pain. However, the specific radiation to the scrotum and the combination with chest pain make it less likely.