Differential Diagnosis for Pyelonephritis (Pyelo) vs Pelvic Inflammatory Disease (PID)
Single Most Likely Diagnosis
- Pyelonephritis: This is the most likely diagnosis if the patient presents with symptoms such as flank pain, costovertebral angle tenderness, and urinary symptoms like dysuria and frequency, especially if there is a history of urinary tract infections (UTIs) or underlying urological conditions.
- Pelvic Inflammatory Disease (PID): This is the most likely diagnosis if the patient presents with lower abdominal pain, cervical motion tenderness, and adnexal tenderness, especially if there is a history of sexually transmitted infections (STIs) or multiple sexual partners.
Other Likely Diagnoses
- Lower Urinary Tract Infection (UTI): This diagnosis should be considered if the patient presents with dysuria, frequency, and urgency, but without the systemic symptoms or flank pain suggestive of pyelonephritis.
- Ovarian Cyst or Torsion: This diagnosis should be considered if the patient presents with sudden onset of severe pelvic pain, especially if there is a history of ovarian cysts or previous pelvic surgery.
- Endometriosis: This diagnosis should be considered if the patient presents with chronic pelvic pain, dysmenorrhea, and dyspareunia, especially if there is a history of infertility or previous pelvic surgery.
Do Not Miss Diagnoses
- Ectopic Pregnancy: This diagnosis is critical to consider in any female patient of childbearing age presenting with abdominal pain, especially if there is a history of missed periods, irregular periods, or previous ectopic pregnancy.
- Appendicitis: This diagnosis should be considered if the patient presents with right lower quadrant abdominal pain, fever, and leukocytosis, especially if there is a history of appendicitis or previous abdominal surgery.
- Sepsis: This diagnosis should be considered if the patient presents with systemic symptoms such as fever, tachycardia, and hypotension, especially if there is a history of immunocompromised state or previous infections.
Rare Diagnoses
- Tubo-ovarian abscess: This diagnosis should be considered if the patient presents with severe pelvic pain, fever, and leukocytosis, especially if there is a history of PID or previous pelvic surgery.
- Perinephric abscess: This diagnosis should be considered if the patient presents with flank pain, fever, and leukocytosis, especially if there is a history of pyelonephritis or previous urological conditions.
- Ureteral obstruction: This diagnosis should be considered if the patient presents with flank pain, nausea, and vomiting, especially if there is a history of kidney stones or previous urological conditions.