Differential Diagnosis for CTA Findings
- Single most likely diagnosis:
- Chronic kidney disease or hydronephrosis (due to the dilated upper pole calices visualized in the left kidney)
- Atherosclerotic disease (given the moderate atherosclerosis and shallow penetrating ulcer within atheromatous plaque in the anterior wall of the upper descending aorta)
- Other Likely diagnoses:
- Hypertension (which could be contributing to the atherosclerotic changes and potentially the kidney findings)
- Renal stone or mass (could be causing the dilatation of the upper pole calices)
- Chronic pulmonary disease (although no acute findings are seen, the subsegmental pulmonary arteries are not well visualized, which might suggest some chronic process)
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Aortic dissection or rupture (although the CTA does not show acute dissection or intramural hematoma, the presence of a penetrating ulcer is a risk factor for these conditions)
- Pulmonary embolism (despite no visualized pulmonary embolus, the subsegmental pulmonary arteries are not well seen, and PE can be a deadly condition if missed)
- Renal cell carcinoma or other malignancy (could cause the dilatation of the calices and is important not to miss due to its potential impact on prognosis and treatment)
- Rare diagnoses:
- Vasculitis (such as Takayasu arteritis or giant cell arteritis, which could affect the aorta and lead to the observed changes)
- Fibromuscular dysplasia (a rare condition affecting the renal arteries and potentially causing the observed kidney findings)
- Aortic pseudoaneurysm (could be related to the penetrating ulcer and is a rare but serious condition)