Differential Diagnosis
- Single most likely diagnosis
- Focal liver lesion (possibly a hepatocellular adenoma or a hemangioma) given the 17 mm process in the liver with homogeneous contrast uptake in the arterial phase and some washout in the venous phase, but with contrast retention centrally. This warrants further evaluation for possible liver tumor.
- Other Likely diagnoses
- Pelvic Congestion Syndrome (PCS) due to the presence of varicose veins in the pelvis related to the uterus, which could explain symptoms such as chronic pelvic pain.
- Liver cyst (given the small, punctate cyst in the posterior right hemiliver, though this is likely benign).
- Do Not Miss
- Liver malignancy (e.g., hepatocellular carcinoma): Although the report mentions that malignancy cannot be excluded, the characteristics of the lesion (e.g., size, contrast enhancement pattern) are more suggestive of a benign process. However, given the potential for malignancy, this diagnosis must be considered and ruled out.
- Deep Vein Thrombosis (DVT) or other thromboembolic events: The presence of an 11mm long thrombus in the left ovarian vein with collateral circulation and varicose dilatation of veins in the pelvis raises the concern for thromboembolic disease, although the primary concern here seems to be pelvic congestion syndrome.
- Rare diagnoses
- Liver metastasis: Although less likely given the solitary nature of the liver lesion and its characteristics, metastatic disease to the liver from another primary site is a possibility, especially if there's an unknown primary malignancy.
- Vascular malformations or other rare vascular conditions: The varicose veins and thrombus in the ovarian vein could potentially be part of a more complex vascular malformation or a rare condition affecting the venous system.