Differential Diagnosis for a 16-year-old girl with heavy vaginal bleeding
- Single most likely diagnosis
- Anovulatory uterine bleeding: This condition is the most likely diagnosis given the patient's history of irregular menses, the presence of a thick endometrial stripe on ultrasound, and the absence of any other obvious causes for the bleeding. Anovulatory cycles are common in the first few years after menarche and can lead to unopposed estrogen stimulation of the endometrium, resulting in heavy or prolonged bleeding.
- Other Likely diagnoses
- Dysfunctional uterine bleeding: This diagnosis is similar to anovulatory uterine bleeding and refers to abnormal uterine bleeding that is not caused by other recognizable conditions such as pregnancy, infection, or tumors. It is often associated with anovulatory cycles.
- Thyroid disorders: Although not directly indicated by the provided information, thyroid disorders can cause menstrual irregularities and heavy bleeding. However, this would typically be associated with other symptoms such as weight changes, fatigue, or skin changes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Despite the negative urine pregnancy test, ectopic pregnancy must be considered in any sexually active female with abdominal pain and vaginal bleeding. A negative test does not completely rule out pregnancy, especially if the test was done early.
- Coagulopathy: Although the patient's coagulation studies (PT and activated PTT) are within normal limits, a coagulopathy such as von Willebrand disease could present with heavy menstrual bleeding. This condition would be critical to identify to guide appropriate management.
- Uterine or cervical malignancy: Although rare in this age group, any unusual or unexplained vaginal bleeding warrants consideration of malignancy.
- Rare diagnoses
- Adrenal or ovarian tumors: These could potentially cause hormonal imbalances leading to irregular menses and heavy bleeding, though they would be uncommon in this age group.
- Pituitary disorders: Conditions affecting the pituitary gland, such as a prolactinoma, could lead to hormonal imbalances causing menstrual irregularities.
- Systemic diseases (e.g., lupus, rheumatoid arthritis): Certain systemic diseases can be associated with menstrual irregularities, though they would typically be accompanied by other symptoms.