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Differential Diagnosis for Left-Sided Hydronephrosis and Hydroureter

Single Most Likely Diagnosis

  • Ureteropelvic Junction (UPJ) Obstruction: The presence of a 2 mm calculus at the ureterovesical junction (UVJ) is likely causing an obstruction, leading to left-sided hydronephrosis and hydroureter. This condition is a common cause of obstructive uropathy.

Other Likely Diagnoses

  • Nephrolithiasis with Obstruction: Bilateral nephrolithiasis increases the risk of obstruction, which could be causing the hydronephrosis and hydroureter. The stones may be causing intermittent or persistent obstruction.
  • Ureteral Stricture: A stricture at the UVJ could be causing the obstruction, although the presence of a calculus makes this less likely.
  • Extrinsic Compression: External compression of the ureter, such as from a tumor or lymphadenopathy, could be causing the obstruction, although this would be less common.

Do Not Miss Diagnoses

  • Urothelial Carcinoma: A tumor in the ureter or renal pelvis could be causing the obstruction, and although less common, it is a critical diagnosis not to miss due to its potential for malignancy.
  • Blood Clot Obstruction: In the setting of nephrolithiasis, bleeding could occur, leading to clot formation and obstruction, which would require urgent intervention.
  • Infectious Causes: Pyelonephritis or sepsis could be causing the obstruction, especially if there is an associated infection.

Rare Diagnoses

  • Retroperitoneal Fibrosis: A rare condition characterized by fibrosis in the retroperitoneum, which could be causing external compression of the ureter.
  • Congenital Anomalies: Abnormalities such as a ureteral duplication or ectopic ureter could be contributing to the obstruction, although these would typically be diagnosed earlier in life.
  • Surgical Adhesions: Adhesions from previous surgeries could be causing external compression of the ureter, leading to obstruction.

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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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