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Differential Diagnosis for 49-year-old Male Patient with Hematuria and Left Flank Pain

Single Most Likely Diagnosis

  • Ureteral Calculus: The patient's symptoms of left flank pain and hematuria, combined with the radiographic finding of a 6.5 x 2 mm calcific body in the distal left ureter, make this the most likely diagnosis. The presence of a calculus in the ureter can cause obstruction, leading to pain and bleeding.

Other Likely Diagnoses

  • Urinary Tract Infection (UTI): The patient's elevated WBC count and symptoms of urinary obstruction (inability to urinate without a catheter) could suggest a UTI, possibly secondary to the ureteral calculus.
  • Chronic Kidney Disease (CKD): The patient's elevated creatinine level and mildly decreased e-GFR suggest some degree of kidney dysfunction, which could be contributing to the patient's symptoms.
  • Benign Prostatic Hyperplasia (BPH): The patient is taking tamsulosin, an alpha-blocker commonly used to treat BPH, which could be contributing to the patient's urinary symptoms.

Do Not Miss Diagnoses

  • Kidney Cancer: Although less likely, kidney cancer could present with hematuria and flank pain, and it is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
  • Sepsis: If the patient's UTI or kidney stone becomes infected, it could lead to sepsis, a life-threatening condition that requires prompt recognition and treatment.
  • Retroperitoneal Fibrosis: This rare condition can cause ureteral obstruction and present with similar symptoms, making it a "do not miss" diagnosis due to its potential for significant morbidity if not treated.

Rare Diagnoses

  • Malacoplakia: A rare condition characterized by the formation of granulomatous tissue in the urinary tract, which could present with hematuria and flank pain.
  • Ureteral Stricture: A rare condition where the ureter becomes narrowed, potentially causing obstruction and symptoms similar to those presented by the patient.
  • Sarcoidosis: A systemic disease that can affect the kidneys and urinary tract, potentially causing hematuria and flank pain, although this would be a rare presentation.

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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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