Differential Diagnosis
- Single most likely diagnosis:
- Recurrent well-differentiated neuroendocrine tumor (NET) of the pancreas with hepatic metastases. Justification: The patient has a history of well-differentiated NET of the pancreas, status post distal pancreatectomy, and the current PET/CT scan shows increased uptake of avid hepatic lesions, likely metastases, and focal uptake within the surgical bed, possible residual tumor.
- Other Likely diagnoses:
- Reactive lymphadenopathy: The mildly avid bilateral supraclavicular lymph nodes and bilateral hilar and subcarinal lymph nodes are most likely reactive, given their low SUV values.
- Post-surgical complications: The patient has postsurgical changes of distal pancreatectomy, including suture material, cystogastrostomy, and decreased left pleural effusion and left upper quadrant/splenic fluid collection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Other primary malignancies: Although the patient has a history of NET, it is essential to consider other primary malignancies that could metastasize to the liver or cause lymphadenopathy.
- Infection or abscess: The decreased left pleural effusion and left upper quadrant/splenic fluid collection could be indicative of an infection or abscess, which would require prompt treatment.
- Rare diagnoses:
- Other neuroendocrine tumors: Although the patient has a history of pancreatic NET, it is possible that the patient could have other neuroendocrine tumors, such as carcinoid tumors or pheochromocytomas.
- Lymphoma: The mildly avid lymph nodes could be indicative of lymphoma, although this is less likely given the patient's history and the low SUV values.