Differential Diagnosis
The following differential diagnosis is based on the provided CT scan results of a 28-year-old woman.
Single Most Likely Diagnosis
- Focal liver lesion (possibly a benign tumor such as a hepatocellular adenoma or a hemangioma, but malignancy cannot be ruled out): The 17mm process in the liver with homogeneous contrast uptake in the arterial phase and some washout in the venous phase, along with central contrast retention, suggests a focal liver lesion. The size and characteristics of the lesion warrant further evaluation, potentially including a surgical assessment to determine the nature of the lesion.
Other Likely Diagnoses
- Pelvic Congestion Syndrome (PCS): The presence of varicose veins in the pelvis, related to the uterus, and an 11mm long thrombus in the left ovarian vein with recanalization via collaterals, supports the diagnosis of PCS. This condition is characterized by chronic pelvic pain associated with ovarian and pelvic varices.
- Simple liver cysts: The small, punctate cyst in the posterior right hemiliver is likely a simple cyst, which is a common and usually benign finding.
- Renal cysts: The bilateral simple parenchymal cysts in the kidneys are likely benign and of no clinical significance.
Do Not Miss Diagnoses
- Liver malignancy (e.g., hepatocellular carcinoma, metastasis): Although the characteristics of the liver lesion do not strongly suggest malignancy, it cannot be ruled out without further investigation. Malignancy would have significant implications for treatment and prognosis.
- Ovarian vein thrombosis with pulmonary embolism risk: The thrombus in the ovarian vein, although with recanalization, poses a risk of pulmonary embolism, which is a potentially life-threatening condition.
- Other vascular abnormalities (e.g., arteriovenous malformations): The presence of varicose veins and thrombi suggests the possibility of other vascular abnormalities that could have significant clinical implications.
Rare Diagnoses
- Liver hemangioma with atypical features: While hemangiomas are common, atypical features or large size could suggest other rare diagnoses.
- Focal nodular hyperplasia (FNH) of the liver: This is a rare benign tumor that could present with similar imaging characteristics to the described liver lesion.
- Other rare liver tumors (e.g., hepatoblastoma, epithelioid hemangioendothelioma): These are uncommon and would require specific diagnostic criteria to be considered.