Differential Diagnosis
- Single most likely diagnosis
- Urinary tract infection (UTI) with ureteral obstruction due to a stone: The presence of WBCs, RBCs, bacteria, and leukocyte esterase in the urine, along with the CT findings of hydroureteronephrosis and a 3 mm stone at the ureterovesical junction (UVJ), strongly suggests a UTI complicated by a ureteral stone causing obstruction.
- Other Likely diagnoses
- Cystitis: The urinary bladder wall thickening on CT and the presence of WBCs, bacteria, and leukocyte esterase in the urine support the diagnosis of cystitis, which may be related to the UTI or the ureteral stone.
- Nephrolithiasis with infection: The stone at the UVJ and the presence of infection (as evidenced by the urinalysis results) suggest that the patient has an infected kidney stone.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although not directly indicated by the provided information, any infection, especially one involving the urinary tract and potentially obstructed by a stone, carries a risk of progressing to sepsis, which is life-threatening and requires immediate attention.
- Pyelonephritis: An infection of the kidney, pyelonephritis can be a complication of an untreated UTI, especially in the presence of a ureteral obstruction. It is crucial to consider and treat promptly to prevent severe consequences.
- Rare diagnoses
- Tuberculosis of the urinary tract: Although less common, tuberculosis can infect the urinary tract and cause similar symptoms, including hematuria, proteinuria, and urinary frequency. The presence of a stone and infection might also be seen in this condition, albeit rarely.
- Malignancy (e.g., bladder or renal cancer): While the findings are more suggestive of an infectious and obstructive process, malignancy can sometimes present with similar symptoms, including hematuria and urinary tract obstruction. However, this would be less likely given the acute presentation and the specific findings on urinalysis and CT.