Differential Diagnosis for the Given Symptoms

The symptoms described include a late period, ultrasound findings of 14mm endometrial thickness, an insufficient corpus luteum to support pregnancy, followed by bleeding, cramping, a single big clot, and then cessation of bleeding after two days. Based on these symptoms, the differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis

  • Miscarriage (Spontaneous Abortion): The symptoms of late period, initial bleeding, cramping, and passage of a clot are highly suggestive of a miscarriage. The ultrasound finding of a thick endometrium and the absence of a strong enough corpus luteum to support a pregnancy further support this diagnosis, as they indicate a non-viable pregnancy.

• Other Likely Diagnoses

  • Anovulatory Bleeding: This condition occurs when the ovaries do not release an egg, leading to irregular and sometimes heavy bleeding. The symptoms of bleeding and cramping could fit this diagnosis, especially if there was no actual pregnancy.
  • Threatened Abortion: If the patient was indeed pregnant, the initial bleeding and cramping could indicate a threatened abortion, where the pregnancy is at risk but still viable.

• Do Not Miss Diagnoses

  • Ectopic Pregnancy: Although less likely given the symptoms of bleeding and clot passage, an ectopic pregnancy must be considered, especially if there's any suspicion of pregnancy. Ectopic pregnancies can present with similar symptoms and are life-threatening if not promptly diagnosed and treated.
  • Molar Pregnancy: A molar pregnancy could cause abnormal uterine bleeding and might be suspected if the ultrasound showed abnormal placental tissue, though the described symptoms and findings do not strongly suggest this.

• Rare Diagnoses

  • Decidual Cast: This is a rare condition where the endometrium (decidua) is shed in one piece, sometimes mimicking a miscarriage. It's more commonly associated with hormonal treatments or conditions affecting the endometrium.
  • Endometrial Polyp or Hyperplasia: While these conditions can cause irregular bleeding and a thickened endometrium on ultrasound, they are less likely to cause the acute symptoms of cramping and clot passage described in the scenario.