Differential Diagnosis
- Single most likely diagnosis
- Urinary Tract Infection (UTI) with ureteral obstruction due to a stone: The presence of many bacteria, WBCs, and RBCs in the urine, along with the findings of hydroureteronephrosis and a 3 mm stone at or near the ureterovesical junction (UVJ), strongly suggests a UTI complicated by a ureteral stone causing obstruction.
- Other Likely diagnoses
- Pyelonephritis: The combination of WBCs and bacteria in the urine, along with the imaging findings of hydroureteronephrosis, could also indicate an upper urinary tract infection, such as pyelonephritis.
- Cystitis: The urinary bladder wall thickening and the presence of WBCs, RBCs, and bacteria in the urine support the diagnosis of cystitis, which could be related to the stone or a separate infection.
- 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 indicate infection, it's crucial to consider the possibility of sepsis, especially if the patient shows signs of systemic infection or organ dysfunction.
- Emphysematous Pyelonephritis: This is a severe infection of the kidney that can be life-threatening. Although less likely, given the current information, it's essential to consider in patients with diabetes or immunocompromised states.
- Rare diagnoses
- Xanthogranulomatous Pyelonephritis: A rare form of chronic pyelonephritis that could present with similar imaging findings, although it typically involves more extensive kidney destruction and might not fully explain the acute presentation.
- Tuberculosis of the Urinary Tract: Although rare in many parts of the world, urinary tract tuberculosis could present with chronic infection signs, including sterile pyuria (WBCs in the urine without bacteria on standard cultures), and might cause urinary tract obstruction.