60 year old healthy male has constant pain on the right side, mid-torso. Any idea as to the cause? No bruising, no strenuous activity
The . The differential diagnosis can be broad, though constant quality can be of some utility in differentiating causes. It can simply be musculoskeletal in origin, such as an abdominal wall sprain given the muscular architecture; a hernia can be possible though it should be protuberant and gastrointestinal symptoms tend to develop. A kidney stone can produce recalcitrant pain, especially if it is obstructing. Certainly, gallbladder issues or acute liver disease can be possible but symptoms would be somewhat more undulating and you should have gastrointestinal symptoms such as nausea and/or vomiting. Given that there's no mention of blood thinners such as coumadin, (warfarin) an intraabdominal bleed is less likely. If you have a history of smoking or a family history of abdominal aortic aneurysm, a tear or flap defect can develop, but you should feel gradually worse. This can also be a presentation of a tumor, fluid around the lung, rib bruising or fracture if there's preceding trauma or even referred pain from the back. Other plausible explanations can be ulcers in your esophagus, stomach or proximal intestine. Less likely would be infections or abscesses, collections of purulent fluid/material. You should seek medical attention if this is worsening or not improving as an evaluation with laboratory and radiologic testing would be necessary in reaching a diagnosis. Hope you feel better. Good luck. Darsham gonzalez, md.