Differential Diagnosis for Complex Hypodense Lesion within the Cervix
Single Most Likely Diagnosis
- Retained Products of Conception (RPOC): Given the history of uterine bleeding following an elective abortion, RPOC is a highly plausible cause. The complex hypodense lesion could represent retained tissue, which is a common complication after abortion procedures.
Other Likely Diagnoses
- Cervical Hematoma: A collection of blood within the cervical stroma could appear as a complex hypodense lesion on imaging, especially in the context of recent surgical intervention like an abortion.
- Cervical Abscess: An infected collection of pus within the cervix could present similarly, especially if there was an infection following the abortion.
- Nabothian Cyst: While typically benign and simple in appearance, a large or complicated nabothian cyst could potentially mimic a complex hypodense lesion, though this would be less likely given the clinical context.
Do Not Miss Diagnoses
- Cervical Cancer: Although less likely, it's crucial not to miss a potential malignancy, especially if the patient has risk factors or if the lesion has characteristics concerning for cancer. The history of bleeding is a red flag symptom.
- Invasive Placenta or Placental Remnants: In cases where the abortion was not completed or if there were placental abnormalities, remnants could cause significant bleeding and appear as a complex lesion on imaging.
Rare Diagnoses
- Cervical Sarcoma: Extremely rare, but a sarcomatous lesion could present as a complex hypodense lesion within the cervix.
- Cervical Lymphoma: Primary cervical lymphoma is rare and could potentially appear as a complex lesion, though this would be an uncommon presentation.
- Cervical Metastasis: Metastatic disease to the cervix from another primary site is rare but could present in this manner, especially in patients with known malignancies elsewhere.