Differential Diagnosis

Disease/Condition Differentiating Signs/Symptoms Differentiating Tests

Constrictive Elevated jugular venous pressure,
pericarditis tachycardia, and atrial fibrillation.
Heart sounds: quiet, third heart sound
(ventricular knock) present.
ECG: tachycardia, atrial fibrillation, low-
voltage QRS complexes, T-wave
abnormalities.
Doppler ultrasound: ventricular filling
abnormalities.

Budd-Chiari Abdominal pain, diarrhea, and Doppler ultrasound and abdominal CT:
syndrome progressively worsening ascites. absence of hepatic vein filling.
Abdominal CT: rapid contrast clearing of
caudate lobe.

Portal vein Signs and symptoms of the underlying Magnetic resonance (indirect) or direct
thrombosis cause such as acute pancreatitis angiography: normal hepatic venous
(severe upper abdominal pain radiating pressure gradient (measure of portal
through to the back, vomiting, absent pressure).
bowel sounds, pyrexia, hypovolemic
Doppler ultrasound and abdominal CT: portal
shock, skin discoloration periumbilically
vein filling defect, absence of flow in the
[Cullen sign] and in the flanks [Grey
portal vein.
Turner sign]), ascending cholangitis
(pyrexia, malaise, rigors, right upper
quadrant pain, jaundice, dark urine,
and pale stools), or abdominal sepsis
(pyrexia, abdominal pain, signs of
peritonism).

Splenic vein Signs and symptoms of pancreatitis: Abdominal ultrasound and CT: evidence of
thrombosis severe upper abdominal pain radiating splenic vein thrombosis.
through to the back, vomiting, absent
Magnetic resonance (indirect) or direct
bowel sounds, pyrexia, hypovolemic
angiography: normal hepatic venous
shock, and skin discoloration
pressure gradient (measure of portal
periumbilically (Cullen sign) and in the
pressure).
flanks (Grey Turner sign) in acute
Disease/Condition Differentiating Signs/Symptoms Differentiating Tests
pancreatitis; nonspecific abdominal
pain exacerbated by eating, diarrhea,
steatorrhea, weight loss, and mild
pyrexia in chronic pancreatitis.

Inferior vena cava Signs and symptoms of renal cell Abdominal ultrasound and CT: evidence of
(IVC) obstruction carcinoma: classic triad of hematuria, IVC obstruction.
flank pain, and flank/abdominal mass
with weight loss and hypertension.

Schistosomiasis History of travel to endemic areas. Magnetic resonance (indirect) or direct

angiography: normal hepatic venous
Constitutional symptoms of febrile
pressure gradient (measure of portal
illness: malaise, rigors, sweating,
pressure).
weight loss, anorexia, vomiting,
diarrhea, headache, muscular aches
and weakness, and abdominal pain.
Signs of febrile illness: urticarial rash,
pyrexia, and lymphadenopathy.

Sarcoidosis Lung involvement: dry cough and Chest x-ray findings are dependent on the
dyspnea. stage of disease progression: hilar
lymphadenopathy, diffuse reticulonodular
Skin involvement: altered pigmentation
shadowing (parenchymal disease), and
(hypo- or hyperpigmented);
upper lobe fibrosis.
maculopapular skin lesions on face,
back, and extremities; and erythema Liver biopsy: non-necrotizing/caseating
nodosum on legs. granulomas.
Eye involvement: anterior or posterior
uveitis, dry eyes (sicca), and
glaucoma.

Nodular No differentiating signs and symptoms. Liver biopsy: small regenerative nodules with
regenerative minimal or no fibrosis on reticulin staining.
hyperplasia
Disease/Condition Differentiating Signs/Symptoms Differentiating Tests
Idiopathic portal No differentiating signs and symptoms. Liver biopsy: no evidence of cirrhosis.
hypertension
(hepatoportal
sclerosis)

Vitamin A No differentiating signs and symptoms. History generally reveals exposure.

intoxication, arsenic,
and vinyl chloride
toxicity