Differential Diagnosis for 66-Year-Old Female with Sudden Onset of Chills and Upper Back Pain
- Single Most Likely Diagnosis
- Musculoskeletal strain or sprain: The sudden onset of upper back pain, especially after walking, could indicate a musculoskeletal issue. The absence of other severe symptoms like chest pain or difficulty breathing makes this a plausible explanation.
- Other Likely Diagnoses
- Viral or bacterial infection: The chills and not feeling well could be indicative of an infection. Given the sudden onset, a viral etiology might be more likely, but bacterial infections cannot be ruled out without further testing.
- Gastrointestinal issues: Although there's no vomiting, the dizziness while drinking green tea could suggest some gastrointestinal upset, possibly related to the breakfast consumed or an underlying condition.
- Dehydration: The dizziness, especially after consuming a beverage, might suggest dehydration, possibly exacerbated by the early morning walk and not enough fluid intake.
- Do Not Miss Diagnoses
- Pulmonary embolism (PE): Although there's no reported chest pain or shortness of breath, PE can sometimes present atypically, especially in older adults. The sudden onset of symptoms warrants consideration of this potentially life-threatening condition.
- Aortic dissection: The upper back pain could be a symptom of an aortic dissection, which is a medical emergency. The absence of chest pain does not rule out this condition, as presentations can vary.
- Cardiac issues (e.g., myocardial infarction): While there's no chest pain, cardiac conditions can present with atypical symptoms, especially in women and older adults. The dizziness and not feeling well could be indicative of a cardiac issue.
- Rare Diagnoses
- Spinal infection or abscess: Although less common, infections of the spine can cause back pain and systemic symptoms like chills.
- Pancreatitis: The upper back pain and nausea (if the dizziness while drinking is considered a form of nausea) could, in rare cases, suggest pancreatitis, especially if there's a history of gallstones or hypertriglyceridemia.
- Pneumonia: While the presentation is not typical for pneumonia, it could be considered, especially if there's a history of recent travel, exposure, or underlying lung disease.