29/07/2026
CLINICAL DIAGNOSIS ≠ CONFIRMED DIAGNOSIS
Not every patient comes to us with investigations, and not every patient agrees to undergo them.
In this case, a 20-year-old girl has had a painless swelling over the right hypochondriac abdominal wall for 8–9 years. It began small and has gradually increased in size, without pain, local complications or systemic complaints.
From the history, location, examination and long clinical behaviour, we can form a working clinical diagnosis and consider likely differential diagnoses. But without imaging—and, where indicated, histopathology—we cannot claim a definitive diagnosis.
For students, remember:
Differential diagnosis — What could it be?
Working clinical diagnosis — What does the available clinical evidence suggest is most likely?
Confirmed diagnosis — What has been established with sufficient objective evidence, such as imaging, laboratory investigations or histopathology where appropriate?
Patients may decline investigations for many reasons. Our responsibility is to explain why they are advised, document the patient's decision, recognize red flags, and work within the limits of the information available.
Clinical skill is not about giving a definite label to every case. It is about knowing what is probable, what must be excluded, and when greater diagnostic certainty is necessary.