Differential Diagnosis for an 8-year-old boy with abdominal pain and jaundice
- Single most likely diagnosis:
- Choledochal cyst: This condition is characterized by a congenital anomaly of the bile duct, leading to the formation of a cystic structure that can cause obstructive jaundice and abdominal pain. The presence of a cystic mass in the right upper quadrant, scleral icterus, and elevated direct bilirubin levels support this diagnosis. The ultrasonography findings of an extrahepatic cystic mass also point towards a choledochal cyst.
- Other Likely diagnoses:
- Pancreatic pseudocyst: The elevated lipase levels and epigastric tenderness could suggest a pancreatic pseudocyst, which is a fluid collection in the pancreas that can cause abdominal pain and obstructive jaundice. However, the absence of a history of pancreatitis or trauma makes this diagnosis less likely.
- Biliary atresia: Although biliary atresia typically presents in infancy, it can occasionally be diagnosed later in childhood. The presence of jaundice and a cystic mass could suggest biliary atresia, but the age of the patient and the lack of other characteristic features make this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Pancreatic cancer: Although rare in children, pancreatic cancer can present with abdominal pain, jaundice, and a palpable mass. The elevated lipase levels could also suggest pancreatic involvement.
- Hepatoblastoma: This is a rare liver tumor that can cause abdominal pain, jaundice, and a palpable mass. Although the ultrasonography findings do not specifically suggest hepatoblastoma, it is essential to consider this diagnosis due to its potential severity.
- Rare diagnoses:
- Caroli's disease: This is a rare congenital disorder characterized by non-obstructive dilatation of the intrahepatic bile ducts. It can cause abdominal pain, jaundice, and a cystic mass, but it is much less common than choledochal cyst.
- Congenital hepatic fibrosis: This is a rare genetic disorder that can cause liver fibrosis, jaundice, and a palpable mass. However, it is typically associated with other systemic features and is less likely to present with a cystic mass in the right upper quadrant.