Differential Diagnosis for Liver and Spleen Lesions in a 22-year-old

Given the presentation of liver and spleen lesions in a 22-year-old with symptoms of nausea and vomiting, and normal laboratory results, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Infectious Mononucleosis: This condition, caused by Epstein-Barr virus (EBV), can lead to hepatosplenomegaly (enlargement of the liver and spleen) and is common in young adults. The normal labs might not immediately point to this, but the clinical presentation and age of the patient make it a consideration.
• Other Likely Diagnoses
  • Viral Hepatitis: Although the labs are normal, early stages of viral hepatitis (A, B, C, etc.) can present with non-specific symptoms like nausea and vomiting. Liver lesions could be an early sign.
  • Splenosis: If the patient has a history of trauma, splenosis (implantation of splenic tissue in abnormal locations) could be a cause for spleen lesions.
  • Hemangiomas: These are benign tumors of the liver and spleen that could cause lesions. They are relatively common and usually asymptomatic but could potentially cause nausea and vomiting if they become large enough to exert pressure on surrounding structures.
• Do Not Miss Diagnoses
  • Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can present with liver and spleen involvement. Although less common in young adults without other symptoms, missing this diagnosis could be catastrophic.
  • Metastatic Disease: Although rare in a 22-year-old, certain cancers (like testicular cancer) can metastasize to the liver and spleen. This would be a critical diagnosis not to miss.
  • Tuberculosis: Hepatic and splenic involvement can occur in tuberculosis, especially in endemic areas or in immunocompromised patients. The normal labs do not rule out TB, as it can have a varied presentation.
• Rare Diagnoses
  • Cystic Diseases (e.g., Polycystic Liver Disease, Splenic Cysts): These conditions can cause lesions in the liver and spleen but are less common and might not immediately explain the nausea and vomiting.
  • Sarcoidosis: This autoimmune disease can affect multiple organs, including the liver and spleen, causing lesions. However, it's less common in this age group and would typically have other systemic symptoms.
  • Focal Nodular Hyperplasia (FNH) or Adenomas: These are benign liver tumors that could cause lesions. They are rare and usually asymptomatic but could potentially cause symptoms if they become large.

Each of these diagnoses has a different level of urgency and implications for treatment, emphasizing the importance of a thorough diagnostic workup to determine the underlying cause of the liver and spleen lesions in this young adult.