Differential Diagnosis for Severe Abdominal Pain in a 73-year-old Man
Single most likely diagnosis
- Abdominal aorta: The patient's history of atrial fibrillation and heart failure increases the risk of embolic events, and the severe abdominal pain could be indicative of an aortic dissection or embolism, especially given the patient's age and comorbidities.
Other Likely diagnoses
- Superior mesenteric artery: Embolism or thrombosis in this artery could cause severe abdominal pain, especially in a patient with a history of atrial fibrillation, which increases the risk of embolic events.
- Inferior mesenteric artery: Similar to the superior mesenteric artery, embolism or thrombosis here could cause abdominal pain, although it might be less severe or frequent compared to superior mesenteric artery issues.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Mesenteric vein thrombosis: Although less common than arterial embolism, mesenteric vein thrombosis can cause severe abdominal pain and is potentially life-threatening if not promptly diagnosed and treated.
- Aortic dissection: Given the patient's age and history of hypertension (implied by heart failure), aortic dissection is a critical diagnosis not to miss, as it requires immediate intervention.
Rare diagnoses
- Other embolic or thrombotic events: While less likely, other rare causes of abdominal pain due to embolic or thrombotic events in smaller vessels or unusual locations should be considered if common causes are ruled out.
- Non-vascular causes of abdominal pain: Although the patient's presentation suggests a vascular cause, other rare non-vascular causes (e.g., acute pancreatitis, perforated viscus) should not be entirely dismissed without thorough evaluation.