Differential Diagnosis for Subscapular Hypodensity in the Spleen
Single Most Likely Diagnosis
- Splenic Infarction: This is the most likely diagnosis given the description of a large area of hypodensity in the spleen, which is a common appearance of infarction on imaging. Splenic infarcts can occur due to various reasons such as emboli, thrombosis, or vasculitis.
Other Likely Diagnoses
- Abscess: A possible secondary infection following infarction, which could present as a hypoechoic or hypodense area within the spleen. The clinical context, such as fever and elevated white blood cell count, would support this diagnosis.
- Hematoma: Could be considered if there's a history of trauma, though the description leans more towards an infarct or infectious process.
- Cyst or Pseudocyst: While less likely given the acute presentation suggested by possible infarction and secondary infection, a cyst or pseudocyst could appear as a hypoechoic area.
Do Not Miss Diagnoses
- Septic Emboli: In the context of possible secondary infection, septic emboli to the spleen could have a similar appearance and are critical to identify due to their high morbidity and mortality.
- Malignancy (e.g., Lymphoma, Metastasis): Though less likely, malignancies can cause splenic lesions and are crucial not to miss due to their significant implications for treatment and prognosis.
Rare Diagnoses
- Splenic Artery Aneurysm: Could potentially cause a hypodense area if it has thrombosed or ruptured, but this is less common.
- Echinococcal Cyst: In endemic areas, an echinococcal cyst could present as a hypoechoic lesion in the spleen, though it's a rare occurrence.
- Splenic Lymphangioma: A rare benign tumor that could appear as a hypodense lesion, more commonly found in children.