Differential Diagnosis
The provided CT scan report reveals several findings that require consideration in a differential diagnosis. Here's an organized approach to the potential diagnoses:
- 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
- Hepatocellular Carcinoma (HCC): Although the report mentions that malignancy cannot be excluded, the characteristics of the liver lesion could also be consistent with HCC, especially in the context of risk factors such as cirrhosis or hepatitis B/C infection, which are not mentioned.
- Focal Nodular Hyperplasia (FNH): This benign liver tumor could present similarly on imaging, with a central scar and homogeneous enhancement in the arterial phase.
- Pelvic Congestion Syndrome: The presence of varicose veins in the pelvis, related to the uterus, and an 11mm long thrombus in the left ovarian vein with collateral circulation, supports this diagnosis, which is characterized by chronic pelvic pain associated with pelvic venous incompetence.
- Do Not Miss Diagnoses
- Liver Metastasis: Although less likely given the description, metastatic disease to the liver from another primary site could present as a solitary lesion and must be considered, especially in patients with a history of cancer.
- Intrahepatic Cholangiocarcinoma: A rare but aggressive malignancy that could present as a solitary liver mass, emphasizing the importance of further evaluation.
- Ovarian Vein Thrombosis with Pulmonary Embolism Risk: The thrombus in the ovarian vein increases the risk of pulmonary embolism, a potentially life-threatening condition that requires prompt diagnosis and treatment.
- Rare Diagnoses
- Hepatic Adenoma: A rare benign liver tumor that could have a similar appearance but is less common than hemangioma or FNH.
- Infectious or Inflammatory Liver Lesions: Such as abscesses or granulomas, which could present with atypical imaging features and require specific diagnostic approaches.
- Primary Liver Lymphoma: An exceedingly rare condition that could mimic other liver lesions in imaging studies.
Each of these diagnoses requires careful consideration of the patient's clinical history, laboratory results, and potentially additional imaging or biopsy for definitive diagnosis.