What is the clinical significance of a pinpoint non-obstructing right renal calculus (kidney stone) in a patient with a history of obstructing stone, as seen on a computed tomography (CT) scan of the abdomen and pelvis with intravenous (IV) contrast?

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Differential Diagnosis

  • Single most likely diagnosis
    • Renal colic due to the non-obstructing right renal calculus: This is the most likely diagnosis given the patient's history of obstructing stone and the current finding of a pinpoint non-obstructing right renal calculus.
  • Other Likely diagnoses
    • Diverticulitis: Although the calcification adjacent to the sigmoid colon is unchanged from the prior study and represents a calcified or inspissated contrast within a diverticulum, the patient could still be experiencing diverticulitis, especially if the diverticulum is inflamed.
    • Degenerative joint disease: The mild degenerative changes in the osseous structures could be causing the patient's symptoms, especially if the patient is experiencing back or pelvic pain.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Appendicitis: Although the CT scan shows no evidence of acute appendicitis, this diagnosis should not be missed as it can be life-threatening if not treated promptly.
    • Vasculitis: The CT scan shows no evidence of acute vasculitis, but this diagnosis should be considered as it can be deadly if not treated promptly.
    • Bowel obstruction: Although the CT scan shows no evidence of obstruction or bowel wall thickening, this diagnosis should not be missed as it can be life-threatening if not treated promptly.
  • Rare diagnoses
    • Renal cell carcinoma: Although the kidneys reveal no renal mass, renal cell carcinoma is a rare but possible diagnosis that should be considered, especially if the patient has a history of kidney problems.
    • Lymphoma: Although there are no abnormal masses or lymphadenopathy, lymphoma is a rare but possible diagnosis that should be considered, especially if the patient has a history of cancer.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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