Differential Diagnosis for a 39-year-old Male with Hematuria and Dysuria
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The patient's symptoms of blood in urine (hematuria) and burning with urination (dysuria) are classic for a UTI. The absence of acute intra-abdominal or pelvic abnormalities on the CT scan supports this diagnosis, as UTIs are often not associated with significant radiographic findings.
Other Likely Diagnoses
- Kidney Stones: Although the CT scan did not show evidence of kidney stones, it is possible that a small stone was missed or has already passed. The symptoms of hematuria and dysuria can be consistent with a kidney stone, especially if it is causing irritation or obstruction in the urinary tract.
- Prostatitis: Inflammation of the prostate gland can cause symptoms of dysuria and hematuria, especially in younger men. The absence of other findings on the CT scan does not rule out this diagnosis.
Do Not Miss Diagnoses
- Bladder Cancer: Although less likely in a 39-year-old male, bladder cancer can present with hematuria and dysuria. It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Trauma: Even if the patient does not report any trauma, it is crucial to consider the possibility of internal injury, especially if the patient has a history of recent trauma or has been in a situation where trauma could have occurred.
Rare Diagnoses
- Sickle Cell Disease or Sickle Cell Trait: In patients with sickle cell disease or trait, sickling of red blood cells can occur in the low-oxygen environment of the kidney, leading to hematuria.
- Tuberculosis (TB) of the Urinary Tract: Although rare in many parts of the world, TB can infect the urinary tract and cause symptoms of hematuria and dysuria.
- Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which can be associated with hematuria in some cases.