Differential Diagnosis for 78-year-old Male with Stage 4 Adenocarcinoma of the Prostate
- Single most likely diagnosis:
- Metastatic prostate cancer causing ureteral obstruction: This is the most likely diagnosis given the patient's history of stage 4 adenocarcinoma of the prostate. The cancer may have metastasized to the ureters, causing obstruction and subsequent hydronephrosis.
- Other Likely diagnoses:
- Nephrolithiasis (kidney stones): The patient's vague right upper quadrant pain and abnormal right kidney on ultrasound could be indicative of kidney stones, which are a common cause of obstructive uropathy.
- Urinary tract infection or pyelonephritis: The patient's symptoms and ultrasound findings could also be consistent with a urinary tract infection or pyelonephritis, particularly if the obstruction is causing urinary stasis.
- Benign prostatic hyperplasia (BPH): Although the patient has undergone bilateral orchiectomy, BPH could still be contributing to urinary obstruction and hydronephrosis.
- Do Not Miss diagnoses:
- Ureteral stricture or fistula: These conditions could be causing the obstruction and hydronephrosis, and would require prompt surgical intervention to prevent further complications.
- Retroperitoneal fibrosis: This rare condition could be causing the ureteral obstruction and hydronephrosis, and would require prompt diagnosis and treatment to prevent further complications.
- Sepsis: If the patient's obstruction is causing urinary stasis and infection, sepsis could be a life-threatening complication that needs to be promptly diagnosed and treated.
- Rare diagnoses:
- Primary ureteral cancer: Although rare, primary ureteral cancer could be causing the obstruction and hydronephrosis, and would require prompt diagnosis and treatment.
- Lymphoma or other malignancies: Other malignancies, such as lymphoma, could be causing the obstruction and hydronephrosis, and would require prompt diagnosis and treatment.
- Congenital anomalies of the urinary tract: Although unlikely in a 78-year-old patient, congenital anomalies of the urinary tract could be contributing to the obstruction and hydronephrosis.