Differential Diagnosis for Left Lower Rib Pain
The patient's presentation of left lower rib pain, which began after performing household chores and is exacerbated by activity, suggests a musculoskeletal origin. However, considering her extensive past medical history and age, it's crucial to entertain a broad differential diagnosis. The categories below outline potential diagnoses, ranging from the most likely to rare conditions.
- Single Most Likely Diagnosis
- Musculoskeletal Strain: Given the onset of pain after lifting laundry and its exacerbation with bending, a musculoskeletal strain is the most plausible diagnosis. The patient's history of similar pain after lifting heavy objects further supports this diagnosis.
- Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum could cause localized pain, especially with movement or deep breathing, though the pain's location at the lowest rib makes this less likely.
- Rib Fracture: Although the patient denies any injury, a stress fracture could occur, especially in someone with osteoporosis (potentially related to rheumatoid arthritis or age), and could be exacerbated by lifting.
- Do Not Miss Diagnoses
- Pulmonary Embolism: While less likely given the lack of respiratory symptoms or recent immobilization, pulmonary embolism can present with chest pain and must be considered, especially in patients with risk factors such as immobility or hypercoagulable states.
- Cardiac Ischemia: Although the pain is localized to the left lower rib and does not radiate, atypical presentations of cardiac ischemia can occur, especially in women and the elderly, necessitating consideration of this diagnosis.
- Gallbladder Disease: Right upper quadrant pain is more typical, but gallbladder disease can occasionally refer pain to the lower ribs, especially if the gallbladder is inflamed and irritates the adjacent diaphragm.
- Rare Diagnoses
- Tietze's Syndrome: A rare inflammatory condition of the cartilages and surrounding tissues of the ribs, which could cause localized pain and swelling, though it's less common and typically involves the upper ribs.
- Sickle Cell Crisis: If the patient has sickle cell disease (not mentioned in her past medical history), a crisis could cause bone pain, including rib pain, due to vaso-occlusion.
Each of these diagnoses should be considered in the context of the patient's overall clinical presentation, medical history, and risk factors. Given the resolution of her pain and the absence of alarming symptoms, a thorough history and physical examination, potentially followed by targeted diagnostic tests based on findings, would be the next steps in management.