Differential Diagnosis for 73-year-old with Hematuria
Single most likely diagnosis
- Traumatic bladder injury or contusion: The onset of hematuria after a fall on the ice, worsening with activity, and improvement with increased fluid intake suggests a possible traumatic injury to the bladder. The fact that the blood is a full stream and accompanied by pressure and difficulty beginning urination further supports this diagnosis.
Other Likely diagnoses
- Urinary tract infection (UTI): The presence of hematuria, especially with symptoms worsening in the last week, could be indicative of a UTI. However, the absence of other typical UTI symptoms such as dysuria, frequency, or fever makes this less likely.
- Benign prostatic hyperplasia (BPH): The patient's age and symptoms of difficulty beginning urination and pressure suggest possible BPH. However, BPH typically presents with more prominent obstructive symptoms and less prominent hematuria.
- Kidney stones: The onset of hematuria after a fall could be related to the passage of a kidney stone. However, the lack of severe pain (colic) and the improvement with increased fluid intake make this less likely.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Bladder cancer: Although less likely given the acute onset after trauma, bladder cancer can present with painless hematuria. It is crucial to rule out this diagnosis, especially in an older adult.
- Sepsis from a urinary source: If the patient has a UTI or other urinary infection, there is a risk of sepsis, particularly in older adults. Early recognition and treatment are critical.
- Renal artery or vein thrombosis: These conditions can present with hematuria and are more likely in the setting of trauma. They require prompt diagnosis and treatment to prevent serious complications.
Rare diagnoses
- Arteriovenous malformation (AVM) or fistula: These vascular anomalies can cause hematuria, especially if they are related to the trauma. However, they are rare and would typically require specific imaging studies for diagnosis.
- Sickle cell disease or trait with renal complications: Although rare, sickle cell disease can cause renal complications, including hematuria, especially in the setting of dehydration or other stressors. This diagnosis would be more likely in individuals of certain ethnic backgrounds or with a known family history.