Differential Diagnosis for Rounded Density at Left Vesicoureteric Junction
- Single most likely diagnosis
- Vesicoureteric Stone: This is the most likely diagnosis given the location at the vesicoureteric junction and the description of a rounded density. Stones at this location can cause obstruction and are a common indication for ureteroscopic lithotripsy.
- Other Likely diagnoses
- Phlebolith: As mentioned, a phlebolith could present similarly on imaging. However, phleboliths are typically smaller and less likely to cause significant obstruction compared to a stone. They are a consideration but less likely given the size (5.5 mm) and the clinical context suggesting a need for intervention like ureteroscopic lithotripsy.
- Blood clot: A blood clot could potentially present as a rounded density, especially if it has formed in the context of a stone causing ureteral trauma or in the setting of another ureteral pathology. However, the size and the specific location at the vesicoureteric junction make this less likely than a stone.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignancy (e.g., transitional cell carcinoma): Although less common, a tumor at the vesicoureteric junction could present as a rounded density. Missing a diagnosis of malignancy could have severe consequences, making it crucial to consider, especially if there are atypical features or if the patient does not respond as expected to treatment for a stone.
- Inflammatory or infectious lesions: Certain infections or inflammatory conditions could potentially cause a mass-like lesion at the vesicoureteric junction, though these would be less common and might be accompanied by other symptoms such as fever, pain, or changes in urination.
- Rare diagnoses
- Metastatic disease: Rarely, metastatic disease from another primary cancer could present as a mass at the vesicoureteric junction. This would be an uncommon presentation for metastatic disease but should be considered in patients with a known history of cancer.
- Vascular anomalies: Certain vascular anomalies, such as an arteriovenous malformation, could potentially present as a rounded density, though this would be exceedingly rare and likely accompanied by other clinical findings.