Differential Diagnosis
- Single most likely diagnosis
- Focal liver lesion (possibly hepatocellular carcinoma or metastasis): 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, raises suspicion for a malignant liver tumor.
- Other Likely diagnoses
- Pelvic congestion syndrome: The presence of varicose veins in the pelvis, related to the uterus, and an 11 mm long thrombus in the left ovarian vein with collateral circulation, supports this diagnosis.
- Hemangioma: Although less likely given the description, a hemangioma could present as a focal liver lesion with characteristic contrast enhancement patterns.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Liver metastasis: Given the presence of a focal liver lesion, metastasis from an unknown primary tumor or a known cancer should be considered to ensure timely and appropriate management.
- Hepatocellular carcinoma: As mentioned, the liver lesion's characteristics could be indicative of hepatocellular carcinoma, which is a serious condition requiring prompt diagnosis and treatment.
- Thrombosis of the ovarian vein with potential for pulmonary embolism: The thrombus in the ovarian vein, although with collateral circulation, poses a risk for pulmonary embolism, which is a life-threatening condition.
- Rare diagnoses
- Focal nodular hyperplasia (FNH): A rare benign liver tumor that could present with similar imaging characteristics, although typically it has a central scar and a more homogeneous appearance.
- Intrahepatic cholangiocarcinoma: A rare malignant tumor of the bile ducts within the liver, which could present as a focal liver lesion but is less common than hepatocellular carcinoma or metastasis.