Differential Diagnosis
- Single most likely diagnosis: + Metastatic cancer (e.g., lung, breast, or gastrointestinal cancer) with hepatic steatosis and splenomegaly. This diagnosis is likely due to the presence of multiple indeterminate pulmonary nodules, including a large left upper lobe nodule, and the association of splenomegaly and hepatic steatosis with metastatic disease.
- Other Likely diagnoses: + Lymphoma: The presence of splenomegaly, hepatic steatosis, and pulmonary nodules could be indicative of lymphoma, particularly if the patient has systemic symptoms such as weight loss or night sweats. + Chronic liver disease: Hepatic steatosis and splenomegaly can be seen in chronic liver disease, such as cirrhosis, which may also lead to the development of pulmonary nodules due to hepatopulmonary syndrome. + Infection (e.g., tuberculosis, fungal infections): Although less likely, infections can cause pulmonary nodules, splenomegaly, and hepatic steatosis, particularly in immunocompromised patients.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.): + Pulmonary arteriovenous malformations (PAVMs): Although the CT scan did not show central pulmonary embolism, PAVMs can cause pulmonary nodules and can be life-threatening if ruptured. + Sarcoidosis: This condition can cause pulmonary nodules, splenomegaly, and hepatic involvement, and although less likely, it should not be missed due to its potential for serious complications.
- Rare diagnoses: + Langerhans cell histiocytosis (LCH): This rare condition can cause pulmonary nodules, hepatic steatosis, and splenomegaly, particularly in smokers. + Gaucher's disease: A rare genetic disorder that can cause splenomegaly, hepatic steatosis, and pulmonary nodules due to the accumulation of glucocerebroside.