Differential Diagnosis
- Single most likely diagnosis
- C) Renal abscess: The patient's symptoms, including high fever, vomiting, back pain, and left costovertebral angle tenderness, along with the ultrasonography findings of a fluid-filled, thick-walled cavity in the upper pole of the left kidney, are highly suggestive of a renal abscess. The patient's history of vesicoureteral reflux and recurrent urinary tract infections also increases the risk of developing a renal abscess.
- Other Likely diagnoses
- A) Granulomatous pyelonephritis: This condition can present with similar symptoms, including fever, back pain, and costovertebral angle tenderness. However, it is less likely than a renal abscess given the ultrasonography findings.
- B) Nephroblastoma: Although this is a type of renal tumor that can present with a mass in the kidney, it is less likely to cause acute symptoms like high fever and vomiting. The ultrasonography findings could be consistent with a tumor, but the clinical presentation is more suggestive of an infectious process.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D) Renal infarction: This is a rare but potentially life-threatening condition that can present with acute back pain and fever. Although the ultrasonography findings do not suggest infarction, it is essential to consider this diagnosis to avoid missing a potentially fatal condition.
- Rare diagnoses
- E) Renal tubular acidosis: This is a metabolic disorder that can cause a variety of symptoms, including back pain and fever. However, it is a rare condition and is unlikely to cause the acute symptoms and ultrasonography findings seen in this patient.