Is Tricuspid Regurgitation Still a Possible Cause?

[rocket777]

Hello!

I also posted in a liver forum, but thought maybe someone here would have some input. Thank you in advance to anyone who takes the time the read this!

Background: I'm a 27 yr old female, not overweight but at the high end of the "healthy range" (145/6 lbs at 5'6"), and I have a connective tissue disorder called Ehlers-Danlos Syndrome. I've experienced pain on my ride side under the ribs for about 6 months now. For most of that time it only hurt if I twisted wrong, but now the pain is constant and includes pain in my right shoulder blade. At first I thought it was just a rib out of alignment (I have that issue a lot), but my doc wanted to make sure it wasn't something like kidney stones or gallstones so he had me do an abdominal ultrasound.

The ultrasound came back showing a kidney stone but it was on the left side, so shouldn't be causing the right-sided pain. And the following about my liver:

"Liver: The liver measures 14.8cm. Subtle relative increased echogenicity to the margins of the portal venules is noted which may be due to the patient being very thin with good acoustic transmission. A centrilobular or starry sky pattern accounting for this appearance cannot entirely be excluded. Clinical and laboratory correlation would be recommended to rule out diffuse hepatic process. The liver otherwise appears normal without discrete lesions seen."

My doc said that it means my liver is inflamed, but has never seen a report include something like that before. He had me get a chest x-ray (came back normal) and an echocardiogram to check for valve regurgitation which I guess can be common in people with connective tissue disorders and can cause issues with the liver. That report came back as normal but with trivial regurgitation for the Mitral, Tricuspid, and Pulmonic valves. My doc is referring me to a specialist, but I have to wait a bit while I deal with an insurance switch.

Has anyone seen anything like this before? Could the inflammation of the liver be causing my pain (it seems to be getting worse) or is it more likely something with my ribs? Can "trivial regurgitation" of heart valves cause liver problems over time? The valve issue makes the most sense to me since I've not experiencing any other symptoms like jaundice. The echocardiogram result also listed the "Study Quality" as "Fair". Is it possible there is more significant regurgitation that was missed due to the quality of the test?

Thanks again for reading and I appreciate any responses!

[rocket777]

Thanks Dr. Anitha and Dr. Kaur! That helps me wrap my head around this a bit more. I have another doctor's appointment tomorrow, so hopefully I can get some more information. Glad to hear it is most likely nothing to do with my heart. Thanks again.

[Bhupinder Kaur, MD]

Hello,
From your symptoms it makes sense to get an ultrasound gall bladder and a HIDA scan done. In many patients with biliary pain, particularly in patients with acute cholecystitis (gallbladder inflammation) fever, jaundice and abnormal liver enzymes may be present. It presents as pain under the ribs on the right side and referred pain radiating to the right shoulder as well. Tricuspid regurgitation is less likely to cause these symptoms.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[Paderla Anitha, DNB]

Hi, right heart failure can cause liver engorgement and consequent echogenicity on sonographic patterns. But with this there is usually pedal edema. And mild regurgitation of the tricuspid valve is unlikely to cause this. Usually when the liver cells are damaged the enzymes spill into the blood stream, so elevations of these could be another indication of ongoing liver insult. As in Ehlers-Danlos Syndrome the blood vessels are also affected, the picture could be reflecting this. Your consultation with the specialist should help throw more light on this. Good Luck. Regards.