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)
- Nephrolithiasis (kidney stones could cause the dilatation of the calices)
- Chronic obstructive pulmonary disease (COPD) or other chronic lung conditions (given the suboptimal demonstration of subsegmental pulmonary arteries, which might suggest chronic rather than acute pathology)
- 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 visualized, and PE can be life-threatening)
- Renal cell carcinoma or other malignancies (could cause the dilatation of the calices, although less likely)
- Rare diagnoses:
- Vasculitis (such as Takayasu arteritis) affecting the aorta
- Congenital anomalies of the kidney or urinary tract
- Rare genetic disorders affecting the aorta or kidneys (e.g., Marfan syndrome, Ehlers-Danlos syndrome)