Differential Diagnosis
- Single most likely diagnosis
- Urinary tract infection (UTI) with ureterolithiasis: The presence of WBCs, RBCs, bacteria, and leukocyte esterase in the urine, along with the finding of a 3 mm stone at or near the ureterovesical junction (UVJ) and mild hydroureteronephrosis, strongly suggests a UTI complicated by a kidney stone. The urinary bladder wall thickening also supports the diagnosis of cystitis.
- Other Likely diagnoses
- Pyelonephritis: The presence of WBCs and bacteria in the urine, along with the finding of hydroureteronephrosis, could indicate an upper urinary tract infection.
- Cystitis: The urinary bladder wall thickening and the presence of WBCs, RBCs, and bacteria in the urine support the diagnosis of cystitis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient's presentation does not explicitly suggest sepsis, any infection in the urinary tract can potentially lead to sepsis, especially if not promptly treated.
- Obstructive uropathy: The presence of a stone at the UVJ and hydroureteronephrosis indicates a potential obstruction, which can lead to serious complications if not addressed.
- Rare diagnoses
- Tuberculosis of the urinary tract: Although rare, tuberculosis can cause similar symptoms and findings, including sterile pyuria (WBCs in the urine without bacteria).
- Malignancy: A tumor in the urinary tract could cause obstruction and infection, although this would be less likely given the acute presentation and the presence of a stone.