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 leukocyte esterase and proteinuria, strongly suggests a UTI. The CT findings of mild left hydroureteronephrosis and a 3 mm stone at or near the ureterovesical junction (UVJ) indicate that the stone is likely causing an obstruction, which is complicating the UTI.
- Other Likely diagnoses
- Cystitis: The urinary bladder wall thickening on CT and the presence of blood, protein, and WBCs in the urine support the diagnosis of cystitis, which could be related to the UTI.
- Ureteral obstruction without infection: Although less likely given the evidence of infection, the stone at the UVJ could be causing obstruction without significant infection, leading to hydroureteronephrosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Given the elevated WBC count in the blood (14.8) and evidence of a UTI, there is a risk of sepsis, especially if the infection is not promptly and adequately treated.
- Pyelonephritis: The presence of WBCs and RBCs in the urine, along with hydroureteronephrosis, could indicate pyelonephritis, an infection of the kidney, which is a serious condition requiring prompt treatment.
- Emphysematous pyelonephritis or cystitis: Although rare, these are serious, potentially life-threatening infections that could present with similar symptoms and findings, especially in diabetic or immunocompromised patients.
- Rare diagnoses
- Tuberculosis of the urinary tract: This could present with similar findings, including sterile pyuria (WBCs in the urine without bacterial growth), but it is less common and would typically have a more chronic presentation.
- Malignancy (e.g., bladder or renal cancer): While the findings could be suggestive of a malignancy, especially the bladder wall thickening, this would be less likely given the acute presentation and the presence of infection. However, it should be considered, especially if the patient does not respond to treatment for the presumed UTI or if there are other suspicious findings.