Differential Diagnosis for Telangiectasias

The patient presents with telangiectasias on the nose and costophrenic angles of the bilateral inferior rib cage, along with cherry hemangiomas. Given the patient's history and physical findings, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Hepatic Hemochromatosis or Other Liver Conditions with Portal Hypertension: Although the patient has normal fibroscans and abdominal CT, the presence of telangiectasias, especially in the context of feeling light pressure under the rib cage when drinking (which could imply a relation to alcohol consumption, even if infrequent), suggests the possibility of underlying liver disease. The normal labs do not entirely rule out early or mild forms of liver conditions that could lead to portal hypertension, a known cause of telangiectasias.

• Other Likely Diagnoses

  • Hereditary Hemorrhagic Telangiectasia (HHT): This genetic disorder is characterized by the presence of multiple telangiectasias and can also include cherry hemangiomas. The patient's symptoms could align with HHT, especially if there's a family history.
  • Ataxia-Telangiectasia: Although more commonly associated with neurological symptoms and immunodeficiency, ataxia-telangiectasia can present with telangiectasias. However, the lack of mentioned neurological symptoms makes this less likely.
  • Chronic Sun Exposure: The patient's telangiectasias on the nose could be related to chronic sun exposure, which is a common cause of telangiectasias in sun-exposed areas.

• Do Not Miss Diagnoses

  • Hepatocellular Carcinoma or Other Malignancies: Although the patient has had normal abdominal CT scans, the possibility of a malignancy, especially hepatocellular carcinoma in the context of potential liver disease, must be considered due to its severe implications.
  • Systemic Sclerosis (Scleroderma): This autoimmune disease can cause telangiectasias, among other symptoms. It's crucial to rule out systemic sclerosis due to its potential for significant morbidity.

• Rare Diagnoses

  • Klippel-Trenaunay-Weber Syndrome: A rare congenital malformation that can include telangiectasias, among other vascular anomalies.
  • Bloom Syndrome: A rare genetic disorder characterized by short stature, a long narrow face, and telangiectasias, among other features.
  • Nevus Flammeus (Port-Wine Stain): While not typically presenting as telangiectasias in the costophrenic angles, it's a consideration for vascular malformations, though it usually presents at birth or early childhood.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and potentially additional diagnostic testing to determine the underlying cause of the telangiectasias.