Differential Diagnosis for Left Lower Back Pain with CTA Tenderness
Single Most Likely Diagnosis
- Musculoskeletal strain: This is the most common cause of lower back pain, often resulting from overuse, heavy lifting, or sudden movement. The presence of CTA (costovertebral angle) tenderness may indicate localized inflammation or strain in the muscles or ligaments surrounding the spine.
Other Likely Diagnoses
- Kidney stone: Pain from a kidney stone can radiate to the lower back and may cause CTA tenderness. The pain is often severe and may be accompanied by nausea, vomiting, or changes in urination.
- Pyelonephritis: An infection of the kidney can cause lower back pain, fever, and CTA tenderness. This condition may also present with symptoms like dysuria, frequent urination, or flank pain.
- Degenerative disc disease: Wear and tear on the spinal discs can lead to lower back pain, which may be exacerbated by certain movements or positions. CTA tenderness could be present if the degeneration affects the discs near the costovertebral angle.
Do Not Miss Diagnoses
- Abdominal aortic aneurysm: Although less common, an abdominal aortic aneurysm can present with lower back pain and may cause CTA tenderness due to the proximity of the aorta to the spine. This is a medical emergency that requires immediate attention.
- Pneumonia: In some cases, pneumonia can cause referred pain to the lower back, especially if the infection involves the lower lobes of the lungs. CTA tenderness might be present due to the inflammation of the adjacent tissues.
- Spinal infection or abscess: Infections like osteomyelitis or discitis can cause severe back pain, fever, and CTA tenderness. These conditions are serious and require prompt medical intervention.
Rare Diagnoses
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that radiates to the back. While less common, pancreatitis should be considered in the differential diagnosis, especially if there are other symptoms like nausea, vomiting, or abdominal tenderness.
- Retroperitoneal hemorrhage: Bleeding into the retroperitoneal space can cause lower back pain and CTA tenderness. This is a rare but potentially life-threatening condition that may require immediate surgical intervention.