Differential Diagnosis

• Single most likely diagnosis
  • Metastatic pancreatic neuroendocrine tumor: This diagnosis is the most likely due to the patient's history of pancreatic neuroendocrine tumor and the presence of arterially enhancing hepatic metastases that have increased in size since the previous MRI.
• Other Likely diagnoses
  • Liver metastases from other primary tumors: Although the patient has a history of pancreatic neuroendocrine tumor, it is possible that the liver metastases are from a different primary tumor.
  • Hepatic adenomas or other benign liver lesions: The arterially enhancing lesions in the liver could potentially be benign lesions such as hepatic adenomas, although this is less likely given the patient's history of cancer.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Hepatocellular carcinoma: Although the patient's liver lesions are likely metastases from the pancreatic neuroendocrine tumor, it is possible that they could be hepatocellular carcinomas, which would require different treatment.
  • Intra-abdominal infection or abscess: The loculated perisplenic fluid could potentially be an abscess or infected fluid collection, which would require prompt antibiotic treatment or drainage.
• Rare diagnoses
  • Primary liver cancer (e.g. cholangiocarcinoma, angiosarcoma): Although rare, it is possible that the patient could have a primary liver cancer that is presenting with arterially enhancing lesions.
  • Lymphoma or other hematologic malignancy: The patient's liver lesions could potentially be due to a lymphoma or other hematologic malignancy, although this is less likely given the patient's history of pancreatic neuroendocrine tumor.