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
- Pyelonephritis: The combination of UTI symptoms with the finding of hydroureteronephrosis suggests possible involvement of the kidney, indicating pyelonephritis.
- 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 or the stone.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although not directly indicated, any infection, especially one complicated by obstruction, has the potential to lead to sepsis, a life-threatening condition.
- Emphysematous Pyelonephritis: A rare but serious condition that can occur in diabetic patients or those with urinary tract obstruction, characterized by gas in the renal parenchyma.
- Ureteral rupture or perforation: Though less likely, obstruction by a stone could potentially lead to ureteral rupture, especially if there's significant obstruction and infection.
- Rare diagnoses
- Xanthogranulomatous Pyelonephritis: A rare form of chronic pyelonephritis that can cause obstructive uropathy and might present with similar imaging findings.
- Malakoplakia: A rare inflammatory condition that can affect the urinary tract and might present with similar symptoms and imaging findings, though it's more commonly associated with bladder involvement.