Differential Diagnosis
The patient's presentation is complex, with multiple findings on the CT abdomen and abnormal laboratory results. Here's a categorized differential diagnosis:
Single most likely diagnosis:
- Hematoma: Given the history of hemostasis clips in the stomach, a recent procedure or bleeding event is likely. The decreased size of the cystic structure along the falciform ligament could represent a resolving hematoma. The patient's low hemoglobin and hematocrit levels also support a diagnosis of recent bleeding.
Other Likely diagnoses:
- Choledochal cyst: Although less likely given the decreased size of the cystic structure, a choledochal cyst cannot be entirely ruled out without further imaging or diagnostic tests.
- Bolina (likely referring to a biloma, which is a collection of bile outside the biliary tree): This could be a complication of a biliary procedure or disease, but the lack of specific biliary findings on the CT makes it less likely.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Liver disease or cirrhosis: The patient's significantly elevated INR (6.2) and prothrombin time (54.3) suggest a coagulopathy, which could be due to liver disease. This would be critical to diagnose and manage to prevent further bleeding complications.
- Sepsis or severe infection: Although minimal diverticulitis is noted, any infection in a patient with significant coagulopathy and thrombocytopenia (platelet count 91) could rapidly become severe and life-threatening.
Rare diagnoses:
- Other rare causes of cystic structures along the falciform ligament, such as a mesothelial cyst or a cystic lymphangioma, are possible but less likely given the clinical context.
- Vascular malformations or pseudoaneurysms could also present with similar imaging findings but would be less common and might not fully explain the patient's coagulopathy and thrombocytopenia.