Differential Diagnosis for Right Lower Back Pain in a 59-year-old Female
Single Most Likely Diagnosis
- Musculoskeletal strain: Given the acute onset of right lower back pain, the most likely diagnosis is a musculoskeletal strain, which could be due to overuse, lifting, or sudden movement. This condition is common and often presents with localized pain and tenderness.
Other Likely Diagnoses
- Urinary tract infection (UTI) or pyelonephritis: These conditions can cause flank pain or lower back pain, especially if the infection involves the kidneys. The patient's age and sex make her more susceptible to UTIs.
- Kidney stones: Nephrolithiasis can cause severe, acute pain in the flank or lower back, often radiating to the groin. The pain can be constant or colicky.
- Degenerative disc disease or herniated disc: As people age, the spinal discs can degenerate or herniate, causing back pain. This condition might be more chronic but can have acute exacerbations.
Do Not Miss Diagnoses
- Abdominal aortic aneurysm (AAA): Although less common, an AAA can present with back pain, especially if it is leaking or ruptured. This is a medical emergency that requires immediate attention.
- Pulmonary embolism: In some cases, a pulmonary embolism can cause referred pain to the back. This condition is life-threatening and requires prompt diagnosis and treatment.
- Ovarian torsion or rupture: These gynecological emergencies can cause severe, acute lower abdominal or back pain. They are more common in women and require immediate surgical intervention.
Rare Diagnoses
- Spinal infection (osteomyelitis, discitis): Infections of the spine can cause back pain and are more common in individuals with certain risk factors, such as immunocompromised states or recent spinal procedures.
- Pancreatitis: Acute pancreatitis can cause severe abdominal pain that radiates to the back. It is less common but should be considered, especially if the patient has a history of gallstones or alcohol abuse.
- Retroperitoneal hemorrhage: Bleeding into the retroperitoneal space can cause back pain and is often associated with trauma, anticoagulation, or vascular abnormalities.