Differential Diagnosis
- Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The presence of moderate bacteria, blood, and protein in the urine, along with a elevated CRP, suggests a UTI. The absence of hydronephrosis and ureteral stones makes an obstructive cause less likely, but the infection could be causing the mild ileus or nonspecific gastroenteritis seen on the CT scan.
- Other Likely Diagnoses
- Cholecystitis or Gallbladder Disease: Although there's no pericholecystic inflammatory change, gallbladder wall thickening, or biliary ductal dilatation, the possible faint density in the gallbladder could indicate small gallstones or sludge, which might be causing intermittent symptoms.
- Ovarian Cyst or Follicular Disease: The presence of multiple small follicles in the ovaries, particularly more on the left, could be indicative of ovarian cysts or a follicular disorder. However, without specific symptoms or further imaging, this remains speculative.
- Nonspecific Gastroenteritis: The CT findings of fluid in portions of the small bowel and colon could be due to a viral or bacterial gastroenteritis, which might also explain the elevated CRP and mild ileus.
- Do Not Miss Diagnoses
- Pyelonephritis: Despite the absence of hydronephrosis, the presence of blood, protein, and bacteria in the urine, along with a significant inflammatory response (CRP 41.2), necessitates consideration of pyelonephritis, especially if the patient has symptoms like flank pain or fever.
- Appendicitis: Although the CT report mentions no evidence of appendicitis, this diagnosis can sometimes be missed, especially if the appendix is not well visualized or if the disease is early. Clinical correlation with symptoms like right lower quadrant pain is crucial.
- Septic Shock or Sepsis: The elevated CRP, bandemia (increased band absolute count), and the presence of a potential infection source (UTI, possible gallbladder disease) raise the concern for sepsis or impending septic shock, which would be a medical emergency.
- Rare Diagnoses
- Ovarian Torsion: Although less likely given the absence of specific symptoms or significant ovarian enlargement, ovarian torsion is a rare but emergency condition that could present with nonspecific abdominal pain and should be considered, especially if there's a significant discrepancy in ovarian size or if the patient has risk factors.
- Gallbladder Cancer: The possible faint density in the gallbladder could, in rare cases, represent a gallbladder cancer, especially if there are risk factors or if further imaging characteristics suggest this possibility.