Differential Diagnosis

• Single most likely diagnosis
  • Hepatocellular carcinoma: This is the most likely diagnosis given the patient's history of alcoholism, which is a risk factor for cirrhosis, and the presence of multiple lesions in the liver on CT scan. The elevated alpha-fetoprotein (AFP) level is also a strong indicator of hepatocellular carcinoma, as AFP is a tumor marker commonly associated with this type of cancer.
• Other Likely diagnoses
  • Metastatic liver disease: Although less likely than hepatocellular carcinoma given the context, metastatic liver disease could present with multiple liver lesions and could be a consideration, especially if there's a known primary malignancy elsewhere in the body. However, the elevated AFP and the presence of cirrhosis make hepatocellular carcinoma more likely.
• Do Not Miss diagnoses
  • Pancreatic cancer with liver metastases: While the CT scan shows liver lesions and cirrhosis, and the clinical presentation might lean more towards a primary liver pathology, pancreatic cancer can metastasize to the liver and cause similar symptoms. It's crucial not to miss this diagnosis, as it has significant implications for treatment and prognosis. However, the elevated AFP is less commonly associated with pancreatic cancer.
• Rare diagnoses
  • Other primary liver cancers or rare liver tumors: These could include intrahepatic cholangiocarcinoma, hepatoblastoma, or other rare liver tumors. While these are less likely given the clinical context and the presence of cirrhosis, they should be considered in the differential diagnosis, especially if further investigation is warranted based on biopsy results or other diagnostic tests.
  • Non-neoplastic causes of liver lesions: Although the clinical presentation and imaging suggest a malignant process, non-neoplastic causes such as abscesses, granulomatous disease, or other inflammatory conditions could potentially present with liver lesions and should be considered, especially if the patient's clinical course does not respond as expected to treatment for hepatocellular carcinoma.