Differential Diagnosis for 45 y/o Female with Abnormal Uterine Bleeding
Single Most Likely Diagnosis
- Endometrial Hyperplasia: This condition is characterized by the thickening of the endometrium, which is consistent with the ultrasound findings of endometrial thickening measuring 14mm. Abnormal uterine bleeding is a common symptom, and the patient's age also puts her in a higher risk category for this condition.
Other Likely Diagnoses
- Hemorrhagic Ovarian Cyst: The presence of a right ovary hemorrhagic cyst, as indicated by the ultrasound, could be contributing to the abnormal uterine bleeding. These cysts can rupture and cause bleeding, which might explain the patient's symptoms.
- Endometrial Polyps: These are growths in the lining of the uterus (endometrium) and can cause abnormal uterine bleeding. The endometrial thickening seen on ultrasound could be due to polyps.
- Uterine Fibroids: Although not directly mentioned, fibroids are common in this age group and can cause abnormal uterine bleeding and endometrial thickening due to their potential to distort the uterine cavity.
Do Not Miss Diagnoses
- Endometrial Cancer: Although less likely than hyperplasia, endometrial cancer must be considered, especially with significant endometrial thickening. It's crucial to rule out cancer due to its severe implications.
- Infection (e.g., Pelvic Inflammatory Disease): The low neutrophil count (1.67) might not directly suggest an infection, but it's essential to consider, especially if there are other symptoms like pelvic pain or fever.
- Coagulopathy: An underlying bleeding disorder could contribute to abnormal uterine bleeding and should be considered, especially if there's a history of easy bruising, heavy menstrual bleeding since menarche, or a family history of bleeding disorders.
Rare Diagnoses
- Uterine Sarcoma: A rare type of cancer that originates in the muscle and supporting tissues of the uterine walls. It's much less common than endometrial cancer but should be considered in the differential due to its aggressive nature.
- Gestational Trophoblastic Disease: Although rare and typically associated with pregnancy, it can cause abnormal uterine bleeding and should be considered if there's any possibility of pregnancy or abnormal pregnancy tissue.