Differential Diagnosis
- Single most likely diagnosis
- Urinary Tract Infection (UTI) with ureteral stone obstruction: This diagnosis is the most likely due to the presence of many bacteria, WBCs, and RBCs in the urine, along with the patient's WBC count of 14.8, indicating an infectious process. The CT findings of a 3 mm stone at or near the ureterovesical junction (UVJ) and mild left hydroureteronephrosis support this diagnosis.
- Other Likely diagnoses
- Pyelonephritis: This diagnosis is likely due to the presence of WBCs and bacteria in the urine, along with the patient's WBC count, indicating an upper urinary tract infection.
- Cystitis: The CT findings of 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 not explicitly indicated, the patient's WBC count and the presence of a UTI with possible obstruction could lead to sepsis if not promptly treated.
- Emphysematous pyelonephritis or cystitis: These are rare but life-threatening conditions that could present with similar symptoms and findings, especially in diabetic or immunocompromised patients.
- Rare diagnoses
- Tuberculosis of the urinary tract: This diagnosis could present with similar symptoms, including hematuria and pyuria, but would be less likely without other supporting evidence, such as a history of TB exposure or systemic symptoms.
- Interstitial nephritis: This diagnosis could present with similar laboratory findings, but would be less likely without other supporting evidence, such as a history of NSAID or antibiotic use.