Differential Diagnosis for 72M with Pancreatic Mass and Vision Loss
Single Most Likely Diagnosis
- Metastatic pancreatic cancer to the eye or brain, causing vision loss: The patient's history of pancreatic mass and elevated liver enzymes suggests advanced pancreatic cancer, which can metastasize to various parts of the body, including the eye or brain, leading to vision loss.
Other Likely Diagnoses
- Diabetic retinopathy: Given the patient's age and potential for undiagnosed or unmanaged diabetes, diabetic retinopathy is a possible cause of vision loss.
- Hypertension-related retinopathy: Uncontrolled hypertension can cause retinopathy, leading to vision loss.
- Age-related macular degeneration: A common cause of vision loss in older adults, which could be contributing to the patient's symptoms.
- Stroke or transient ischemic attack (TIA): The patient's age and potential for vascular disease increase the risk of stroke or TIA, which can cause sudden vision loss.
Do Not Miss Diagnoses
- Giant cell arteritis: A condition that can cause sudden vision loss, especially in older adults, and requires prompt treatment to prevent further vision loss.
- Retinal detachment: A medical emergency that requires immediate attention to prevent permanent vision loss.
- Brain tumor or metastasis: Although less likely, a brain tumor or metastasis could be causing the patient's vision loss, and missing this diagnosis could have severe consequences.
- Endogenous endophthalmitis: A rare but potentially deadly infection that can cause vision loss, especially in patients with a history of cancer or immunosuppression.
Rare Diagnoses
- Ocular lymphoma: A rare type of cancer that can cause vision loss, especially in older adults or those with a history of cancer.
- Choroidal melanoma: A rare type of eye cancer that can cause vision loss, especially if it metastasizes to other parts of the body.
- Neurosyphilis: A rare condition that can cause vision loss, especially in patients with a history of syphilis or immunosuppression.
- Vitamin B12 deficiency-related optic neuropathy: A rare condition that can cause vision loss, especially in patients with a history of vitamin B12 deficiency or malabsorption.