Differential Diagnosis

• Single most likely diagnosis
  • Budd-Chiari syndrome: This condition is characterized by the occlusion of the hepatic veins, which is consistent with the abdominal ultrasound findings in this patient. The use of oral contraceptives is also a known risk factor for Budd-Chiari syndrome, as it can increase the risk of thrombosis.
• Other Likely diagnoses
  • Acute choledocholithiasis: Although the ultrasound findings do not directly support this diagnosis, the patient's symptoms of nausea, abdominal pain, and jaundice could be consistent with a gallstone obstructing the common bile duct. However, the specific finding of occlusion of the right hepatic vein makes this less likely.
• Do Not Miss
  • Acute intermittent porphyria: This is a rare genetic disorder that can cause abdominal pain, nausea, and neurological symptoms. While it is not the most likely diagnosis, it is important to consider because it can be life-threatening if not recognized and treated promptly.
• Rare diagnoses
  • Erythropoietic porphyria: This is a rare genetic disorder that affects the production of heme, leading to sensitivity to sunlight and other symptoms. It is unlikely to be the cause of this patient's symptoms, but it is included in the differential diagnosis for completeness.
  • Hemochromatosis: This is a genetic disorder that leads to iron overload, which can cause liver damage and other symptoms. While it is possible that this patient could have hemochromatosis, the acute presentation and specific findings on ultrasound make it a less likely diagnosis.