Differential Diagnosis
The provided CT scan report of a 28-year-old woman reveals several findings that need to be considered for a comprehensive differential diagnosis. The key findings include a 17 mm process in the liver, varicose veins in the pelvis suggesting pelvic congestion syndrome, and an 11mm long thrombus in the left ovarian vein with collateral circulation.
- Single Most Likely Diagnosis
- Liver Hemangioma: The 17 mm process in the liver with homogeneous contrast uptake in the arterial phase and some washout in the venous phase, along with central contrast retention, could be suggestive of a liver hemangioma. This is a common benign liver lesion.
- Other Likely Diagnoses
- Focal Nodular Hyperplasia (FNH): This benign liver tumor could also present with similar imaging characteristics, including homogeneous enhancement in the arterial phase.
- Hepatocellular Adenoma: Although less likely given the patient's age and lack of specific risk factors, this benign liver tumor could present with arterial phase enhancement.
- Pelvic Congestion Syndrome: The presence of varicose veins in the pelvis and an ovarian vein thrombus supports this diagnosis, which is characterized by chronic pelvic pain associated with pelvic venous incompetence.
- Do Not Miss Diagnoses
- Hepatocellular Carcinoma (HCC): Although the report mentions that malignancy cannot be excluded, the characteristics are not highly suggestive of HCC. However, given the potential severity, it's crucial not to miss this diagnosis.
- Liver Metastasis: Any liver lesion, especially one with atypical features, warrants consideration of metastatic disease, although there's no clear indication of a primary malignancy in the provided information.
- Ovarian Vein Thrombosis Complications: The thrombus in the ovarian vein, while currently compensated by collateral circulation, could potentially lead to more severe complications like pulmonary embolism or could be a sign of an underlying hypercoagulable state.
- Rare Diagnoses
- Hepatic Angiosarcoma: A rare malignant tumor of the liver that could present with similar imaging findings, although it is much less common than other liver lesions.
- Intrahepatic Cholangiocarcinoma: A rare primary liver cancer that might present as a mass lesion, though typically with more aggressive features on imaging.
Each of these diagnoses requires careful consideration of the patient's clinical presentation, laboratory findings, and potentially additional imaging or diagnostic procedures to confirm the nature of the liver lesion and the pelvic venous abnormalities.