Differential Diagnosis
- Single most likely diagnosis
- Urinary Tract Infection (UTI) with obstructing ureteral stone: The presence of many bacteria, WBCs, and RBCs in the urine, along with the finding of a 3 mm stone at or near the ureterovesical junction (UVJ) and mild left hydroureteronephrosis, strongly suggests a UTI complicated by an obstructing stone.
- Other Likely diagnoses
- Pyelonephritis: The combination of WBCs and bacteria in the urine, along with the finding of hydroureteronephrosis, could indicate an upper urinary tract infection.
- Cystitis: The urinary bladder wall thickening and the presence of WBCs, RBCs, and bacteria in the urine support this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient's CBC shows an elevated WBC count, which could be indicative of an infection, it's crucial to consider sepsis, especially if the patient shows signs of systemic illness, as it can be life-threatening.
- Emphysematous Pyelonephritis: This is a severe infection of the kidney that can be life-threatening, especially in diabetic patients. Although not directly suggested by the findings, it's a critical diagnosis to consider in the context of a UTI and urinary obstruction.
- Rare diagnoses
- Xanthogranulomatous Pyelonephritis: A rare form of chronic pyelonephritis that could present with similar imaging findings, although it's less likely given the acute presentation suggested by the lab results.
- Tuberculosis of the Urinary Tract: Could present with sterile pyuria (WBCs in the urine without bacteria), but the presence of many bacteria makes this less likely. However, it's a consideration in endemic areas or in patients with risk factors.