Differential Diagnosis for 77 year old female with left lower back pain
- Single most likely diagnosis
- Musculoskeletal strain: Given the patient's age and the fact that the pain is worse with movement, a musculoskeletal strain is a plausible diagnosis. The radiation of pain to the left lower quadrant (LLQ) could be referred pain from the back muscles.
- Other Likely diagnoses
- Kidney stone: Although the patient denies changes in urination, kidney stones can cause severe back pain that radiates to the LLQ, accompanied by nausea.
- Diverticulitis: The patient's age and the location of the pain make diverticulitis a possible diagnosis, especially if the pain is localized to the LLQ.
- Osteoporotic compression fracture: Given the patient's age and history of Alzheimer's, osteoporosis is a concern, and a compression fracture could cause sudden onset back pain.
- Do Not Miss diagnoses
- Abdominal aortic aneurysm (AAA): Although less likely, AAA is a life-threatening condition that can cause back pain, especially if it is leaking or ruptured. The patient's age and history of diabetes increase the risk.
- Pyelonephritis: A urinary tract infection that has ascended to the kidneys can cause severe back pain, nausea, and vomiting. The patient's denial of changes in urination does not rule out this diagnosis.
- Pancreatitis: The patient's history of diabetes increases the risk of pancreatitis, which can cause severe back pain radiating to the LLQ, accompanied by nausea and vomiting.
- Rare diagnoses
- Spinal epidural abscess: A rare but serious condition that can cause back pain, fever, and neurological deficits. The patient's age and history of diabetes increase the risk.
- Retroperitoneal hemorrhage: A rare condition that can cause back pain, nausea, and vomiting, often associated with anticoagulant use or bleeding disorders.