Differential Diagnosis for 31-year-old with Palpable Lymph Nodes and Fullness under Left Ribs
- Single most likely diagnosis
- Splenomegaly: The fullness under the left ribs, particularly when sitting down, is suggestive of an enlarged spleen. This could be due to various causes such as portal hypertension, infections, or hematological disorders. The presence of palpable lymph nodes could be related to the underlying cause of splenomegaly.
- Other Likely diagnoses
- Lymphoma: Although the patient does not have systemic symptoms like weight loss or fevers, lymphoma can present with lymphadenopathy and splenomegaly. The absence of systemic symptoms does not rule out lymphoma.
- Chronic Liver Disease: Liver diseases such as cirrhosis can lead to splenomegaly due to portal hypertension. The palpable lymph nodes could be reactive or related to the liver disease.
- Mononucleosis: Infectious mononucleosis caused by Epstein-Barr virus can present with lymphadenopathy and splenomegaly. Although the patient does not have fevers, the disease can have a varied presentation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lymphoma with Splenic Involvement: As mentioned earlier, lymphoma is a concern, and splenic involvement can lead to significant morbidity if not addressed promptly.
- Sickle Cell Disease with Splenic Sequestration: Although less common, sickle cell disease can cause splenomegaly and lymphadenopathy. Splenic sequestration is a life-threatening complication that requires immediate attention.
- Tuberculosis: TB can cause lymphadenopathy and splenomegaly, especially in endemic areas. It's crucial to consider TB in the differential diagnosis, given its potential for severe consequences if left untreated.
- Rare diagnoses
- Castleman Disease: A rare lymphoproliferative disorder that can cause lymphadenopathy and splenomegaly. It's essential to consider this diagnosis in patients with unexplained lymphadenopathy and splenomegaly.
- Gaucher's Disease: A genetic disorder that can cause splenomegaly and lymphadenopathy due to the accumulation of glucocerebroside in the spleen and lymph nodes.
- Primary Splenic Lymphoma: A rare type of lymphoma that originates in the spleen and can cause splenomegaly and lymphadenopathy.