Differential Diagnosis
- Single most likely diagnosis
- Pyelonephritis: The patient presents with left flank pain, elevated WBC count (13.8), elevated CRP (23.4), and a urinalysis showing many bacteria and WBCs (50). These findings are consistent with an upper urinary tract infection, such as pyelonephritis. The CT scan showing nonspecific edema in the proximal right renal collecting system also supports this diagnosis, although the pain is on the left side, which might indicate a need for further investigation to rule out other causes or to assess for bilateral involvement.
- Other Likely diagnoses
- Nephrolithiasis (kidney stones): The CT scan mentions nonspecific edema in the proximal right renal collecting system, which could be consistent with a passed calculus causing obstruction and subsequent infection or inflammation. The presence of flank pain also supports this diagnosis.
- Urinary Tract Infection (UTI) with possible sepsis: Given the high WBC count, elevated CRP, and the presence of bacteria in the urine, there's a possibility of a UTI that could be progressing to sepsis, especially if not promptly treated.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient's vital signs are not provided, the elevated WBC count and CRP level, along with the evidence of a bacterial infection, necessitate consideration of sepsis, which is a life-threatening condition.
- Perinephric abscess: This is a serious condition that can arise from untreated or inadequately treated pyelonephritis. It would require urgent drainage and antibiotic therapy.
- Emphysematous pyelonephritis: A rare but serious infection of the kidney, more common in diabetic patients, characterized by gas formation in the kidney tissue. It's a medical emergency.
- Rare diagnoses
- Xanthogranulomatous pyelonephritis: A rare form of chronic pyelonephritis that involves cellular infiltration and destruction of the renal tissue, often associated with long-standing urinary tract obstruction and infection.
- Tuberculosis of the kidney: Although less common, especially in regions with low TB prevalence, it could present with similar symptoms, including flank pain and urinary abnormalities. The diagnosis would require specific testing, such as urine culture for TB or imaging findings suggestive of TB.