Differential Diagnosis for Gross Hematuria with Clots and Urinary Retention
Single Most Likely Diagnosis
- Radiation-induced vascular disease: Given the patient's history of prostate cancer treated with external beam radiation 10 months ago, radiation-induced vascular disease is a plausible cause for the gross hematuria with clots. Radiation can cause damage to the blood vessels in the bladder and urinary tract, leading to bleeding and clot formation.
Other Likely Diagnoses
- Bleeding from prostate cancer recurrence: Although the prostate-specific antigen (PSA) level is within the normal range, it does not entirely rule out the possibility of prostate cancer recurrence, especially in a patient with a history of prostate cancer. Bleeding from a recurrent tumor could cause gross hematuria with clots.
- Urinary tract infection or stones: Infection or stones in the urinary tract could cause irritation, bleeding, and subsequent clot formation, leading to urinary retention.
- Benign prostatic hyperplasia (BPH): The patient's age and history of prostate cancer increase the likelihood of BPH, which can cause urinary retention and bleeding.
Do Not Miss Diagnoses
- Disseminated intravascular coagulation (DIC): Although the patient's laboratory results do not strongly suggest DIC, it is a potentially life-threatening condition that can cause bleeding and clotting. A high index of suspicion is necessary, especially in a patient with a history of cancer and recent radiation therapy.
- Sepsis: Sepsis can cause bleeding, clotting, and organ dysfunction. It is essential to consider sepsis in any patient presenting with acute illness, especially if there are signs of infection or organ dysfunction.
Rare Diagnoses
- Acute leukemia: Leukemia can cause bleeding and clotting due to bone marrow suppression or disseminated intravascular coagulation. However, the patient's laboratory results do not strongly suggest leukemia, making it a less likely diagnosis.
- Atherosclerotic peripheral artery disease: While atherosclerotic disease is common in older adults, it is not typically associated with gross hematuria or urinary retention.
- Hemolytic anemia: Hemolytic anemia can cause bleeding and clotting, but the patient's laboratory results do not suggest hemolysis, making it an unlikely diagnosis.