Differential Diagnosis
- Single most likely diagnosis
- Hematoma: Given the presence of hemostasis clips in the stomach and a history of GI bleed (as suggested by the low hemoglobin and hematocrit levels), along with the finding of a decreased size of a likely cystic structure along the falciform ligament, a hematoma is the most plausible explanation. The structure could be a resolving hematoma.
- Other Likely diagnoses
- Choledochal cyst: Although less likely given the location along the falciform ligament, a choledochal cyst could still be considered, especially if there's any suspicion of biliary anomaly. However, the primary concern here seems to be more related to the hematoma and the GI bleed.
- Bolina (likely referring to a Bohn's abscess or a similar condition, but assuming it might be a typo for "Biloma"): A biloma, which is a collection of bile, could be considered if there's a biliary injury or disease. However, without direct evidence of biliary ductal injury or significant biliary disease, this remains less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Active or ongoing GI bleed: Despite the CT showing no evidence of active GI bleed, the patient's low hemoglobin and hematocrit levels, along with thrombocytopenia, suggest significant blood loss. Continuous monitoring and possibly further investigation (like endoscopy) might be necessary to rule out an ongoing bleed.
- Sepsis from diverticulitis: Although described as minimal, any diverticulitis can potentially lead to sepsis, especially in a patient with signs of possible infection or compromised immune response. The presence of thrombocytopenia could indicate a systemic response.
- Rare diagnoses
- Other rare cystic lesions (e.g., mesenteric cysts, lymphatic malformations): These could be considered if the cystic structure does not behave like a hematoma or biloma. However, without more specific imaging characteristics or clinical findings, these remain speculative.
- Complications of nephrolithiasis: While the non-obstructive nephrolithiasis itself is not immediately life-threatening, it could potentially lead to complications like pyelonephritis or sepsis if infected. However, this seems less directly related to the immediate differential diagnosis for the cystic structure and the patient's current presentation.