Differential Diagnosis for CT Stonogram Findings

The following differential diagnosis is based on the provided CT stonogram findings, which indicate hydro ureter with ureteritis, nephrolithiasis, and a consideration for ureteral stricture versus recent passage of stone, along with an incidental finding suggestive of an angiomyolipoma.

• Single Most Likely Diagnosis

  • Ureteral obstruction due to a stone (recently passed or currently lodged): This is the most straightforward explanation given the presence of hydro ureter, ureteritis, and nephrolithiasis. The symptoms and imaging findings are consistent with a ureteral stone causing obstruction and subsequent inflammation.

• Other Likely Diagnoses

  • Ureteral stricture: This could be a cause of the hydro ureter and ureteritis, especially if there's a history of previous stone passage, instrumentation, or other ureteral injuries. The stricture could be causing obstruction similar to a stone.
  • Infection (pyelonephritis or ureteritis without a stone): While less likely given the context, an infection could cause similar symptoms and findings, especially if there's an underlying anatomical issue or immunocompromised state.

• Do Not Miss Diagnoses

  • Malignancy (e.g., transitional cell carcinoma of the ureter): Although less common, a tumor could cause ureteral obstruction and must be considered to avoid delayed diagnosis. This would be particularly concerning in patients with risk factors such as smoking or exposure to certain chemicals.
  • Vascular issues (e.g., renal vein thrombosis, especially if the suspected angiomyolipoma is large): While the primary concern is the ureteral issue, the mention of an angiomyolipoma raises the possibility of vascular complications, which could be serious.

• Rare Diagnoses

  • Angiomyolipoma with spontaneous hemorrhage: Although angiomyolipomas are typically benign, they can rarely cause significant bleeding, which would be an emergency. The CT might suggest this if there's evidence of recent bleeding or a large tumor.
  • Other rare causes of ureteral obstruction (e.g., blood clots, sloughed papillae, or extrinsic compression from other masses): These are less common but should be considered if other explanations do not fit the clinical and imaging findings.