Differential Diagnosis
- Single most likely diagnosis
- Molar pregnancy: This diagnosis is likely due to the patient's presentation of heavy vaginal bleeding, passage of small clots, pelvic pain, and an enlarged uterus. The elevated serum β-hCG level and the inability to identify a fetal heartbeat by Doppler also support this diagnosis. The patient's recent history of irregular spotting and the fact that her last normal menstrual period was 4 months ago further increase the likelihood of this diagnosis.
- Other Likely diagnoses
- Abnormal intrauterine pregnancy (e.g., miscarriage): The patient's presentation of heavy vaginal bleeding and pelvic pain, along with the elevated β-hCG level, could also be consistent with an abnormal intrauterine pregnancy. However, the absence of a fetal heartbeat and the enlarged uterus make molar pregnancy more likely.
- Thyroid storm: The patient's symptoms of hot flashes, night sweats, palpitations, and tachycardia, along with the low TSH level, could suggest a thyroid storm. However, this diagnosis does not directly explain the patient's vaginal bleeding and pelvic pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although the patient's presentation is more suggestive of a molar pregnancy, an ectopic pregnancy could still be possible, especially given the patient's history of pelvic inflammatory disease. A missed diagnosis of ectopic pregnancy could be life-threatening.
- Uterine rupture: The patient's history of pelvic inflammatory disease and the presence of pelvic pain could increase the risk of uterine rupture, especially if the patient has a uterine scar from a previous surgery.
- Rare diagnoses
- Choriocarcinoma: This is a rare type of cancer that can cause elevated β-hCG levels and vaginal bleeding. However, it is less likely than a molar pregnancy, and the patient's presentation does not strongly suggest this diagnosis.
- Pituitary tumor: The patient's symptoms of hot flashes, night sweats, and palpitations, along with the low TSH level, could suggest a pituitary tumor. However, this diagnosis is rare and does not directly explain the patient's vaginal bleeding and pelvic pain.