Differential Diagnosis

The following differential diagnoses are based on the provided imaging findings:

• Single Most Likely Diagnosis
  • Chronic cystitis: This is a likely cause of the diffuse mural thickening of the bladder, given the absence of other significant findings.
  • Benign prostatic hyperplasia (BPH): The prominent median lobe of the prostate encroaching on the urinary bladder lumen is consistent with BPH, especially in the context of the patient's age and symptoms.
• Other Likely Diagnoses
  • Chronic outflow obstruction: This could be a contributing factor to the mural thickening of the bladder, especially if the patient has a history of urinary retention or other obstructive symptoms.
  • Prostate cancer: Although less likely, the prominent median lobe of the prostate could be a sign of prostate cancer, and correlation with PSA levels and further imaging (e.g., MRI) may be necessary.
• Do Not Miss Diagnoses
  • Bladder cancer: Although the imaging findings are not highly suggestive of bladder cancer, it is a potentially life-threatening condition that should not be missed. Cystoscopy may be recommended to rule out this diagnosis.
  • Kidney cancer: The 3.3 cm exophytic hypodense lesion in the right kidney could be a sign of kidney cancer, and further evaluation (e.g., CT or MRI with contrast) may be necessary to determine the nature of this lesion.
• Rare Diagnoses
  • Neurogenic bladder: This is a less common condition that could cause mural thickening of the bladder, but it would typically be associated with other neurological symptoms or findings.
  • Bladder diverticulum: Although diverticulosis is present in the colon, bladder diverticula are less common and may cause similar symptoms to those presented in this case.

Next Steps

Based on the differential diagnoses, the following steps could be taken:

• Correlate the imaging findings with PSA levels and consider further imaging (e.g., MRI) to evaluate the prostate.
• Perform urinalysis to evaluate for signs of infection or other abnormalities.
• Consider cystoscopy to evaluate the bladder and rule out bladder cancer or other abnormalities.
• Further evaluate the 3.3 cm exophytic hypodense lesion in the right kidney with CT or MRI with contrast to determine its nature.