Differential Diagnosis for a 29-year-old with RUQ Pain after Trauma
Single most likely diagnosis
- Rib fracture: The patient's history of falling into a door nob and subsequent tenderness to palpation in the right upper quadrant (RUQ) makes a rib fracture the most likely diagnosis. The location of the pain and the mechanism of injury are consistent with this diagnosis.
Other Likely diagnoses
- Muscle contusion: The trauma from the fall could have caused a muscle contusion, leading to pain and tenderness in the RUQ.
- Costochondritis: The fall could have also caused inflammation of the cartilage that connects the ribs to the sternum, leading to costochondritis.
- Liver contusion: Although less likely, a liver contusion is possible given the mechanism of injury and the location of the pain.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Splenic rupture: Although the spleen is located in the left upper quadrant, a severe blow to the abdomen can cause splenic rupture, which is a life-threatening condition.
- Hemorrhage: Internal bleeding in the abdominal cavity can occur due to trauma and can be life-threatening if not promptly diagnosed and treated.
- Pneumothorax: A rib fracture can puncture the lung, leading to a pneumothorax, which is a life-threatening condition.
Rare diagnoses
- Gallbladder injury: A rare but possible diagnosis, gallbladder injury can occur due to trauma and may present with RUQ pain.
- Diaphragmatic rupture: A severe blow to the abdomen can cause a diaphragmatic rupture, which is a rare but life-threatening condition.
- Liver laceration: A liver laceration is a rare but possible diagnosis, given the mechanism of injury and the location of the pain.