Differential Diagnosis for Multiple Bilobar Hepatic Lesions
Single Most Likely Diagnosis
- Infectious Abscess: The patient has a history of IR drain placement for multiple bilobar hepatic lesions, and the presence of leukocytosis and necrotic porta hepatic lymphadenopathy suggests an infectious process. The patient's decompensated liver cirrhosis and history of ETOH use also increase the risk of developing infectious complications.
Other Likely Diagnoses
- Hepatic Angiosarcoma: Although less likely than an infectious abscess, the patient's history of liver cirrhosis and the presence of multiple bilobar hepatic lesions could suggest a malignant process such as angiosarcoma.
- Hepatic Peliosis: This rare condition is characterized by the presence of blood-filled cavities within the liver, which could be consistent with the patient's imaging findings.
- Sterile Hematoma: The patient's history of IR drain placement and the presence of perihepatic and pericapsular fluid collections could suggest a sterile hematoma.
Do Not Miss Diagnoses
- Hepatocellular Carcinoma: Although the patient's imaging findings do not specifically suggest HCC, it is a common complication of liver cirrhosis and could be deadly if missed.
- Septic Thrombophlebitis: The patient's extensive intra and extrahepatic portal venous thrombus and DVT of bilateral peroneal veins and left posterior tibial veins increase the risk of septic thrombophlebitis, which could be deadly if not promptly diagnosed and treated.
- Spontaneous Bacterial Peritonitis: The patient's decompensated liver cirrhosis and ascites increase the risk of SBP, which could be deadly if not promptly diagnosed and treated.
Rare Diagnoses
- Hepatic Artery Aneurysm: Although rare, the patient's history of IR drain placement and the presence of multiple bilobar hepatic lesions could suggest a hepatic artery aneurysm.
- Hepatic Lymphangiomatosis: This rare condition is characterized by the presence of multiple cystic lesions within the liver, which could be consistent with the patient's imaging findings.
- Intrahepatic Cholangiocarcinoma: Although rare, the patient's history of liver cirrhosis and the presence of multiple bilobar hepatic lesions could suggest intrahepatic cholangiocarcinoma.