Adbominal issues - concerned

Dear Dr,

I have undergone the following imaging (the original issue was inability to urineate while pregnant - no cause found ):

May 08 abdominal u/s   -    gallbladder polyps largest 5.6mm (two noted)
July 08 abdominal u/s - Gallbladder polyps several largest 5mm
Nov 08 abdominal u/s - 3-4 gallbladder polyps largest 7mm   spleen 10.3cm
Nov 08 abdominal u/s -   3-4 Gallbladder polyps largest 4mm    hypoechoic liver lession 12mmx10mmx8mm  -   spleen 12.6cm
Dec 08 MRI liver  - no focal mass to corrospond to hypoechoic liver lession.   Focal fatty inflitration noted.  4mm gallbladder polyp.    other abdominal organs normal.
Feb 09  abdominal u/s liver only  - hypoechoic liver lession with slight increased area of echnogenicity centraly  12mmx10mmx9mm.
Feb 09 MRI liver - no focal mass noted  - fatty infiltration noted.  no para aortic lymphandnopathy.  no acites (ascites).  liver other wise homogenious.   other abdominal organs normal

May 09  abdominal u/s   --  liver nodule hypoechoic 14mmx12mm  - spleen promenent at 13.4cm  - 3 small gallbladder polyps  no size noted


questions:

1  is a 2mm change in the liver nodule by ultrasound significant????????

2.  what is considered normal for spleen size by ultrasound ??????   I have tried to research and found conflicting info  so is 13.4cm a concern???

3.  does the spleen fluctuate in size as in early nov 08 it was 10.3cm in late nov 08 it was 12.6cm    in both MRi Dec 08 and Feb 09 it was considered to be normal and now in May 09 it is 13.4cm?????

4.  i suffer from recurrant mouth ulcers/cankers  - and during the may 09 u/s had several of these that spred into my throat  - can they be viral/bacterial and therefore cause spleen to go up in size?????  if not what would cause this and will it go back down????????

5 what would be an appropaiate follow up for these issues and when??????


thank you kindly

[Kevin Pho, MD]

To answer your questions:

1) It is somewhat puzzling that a nodule was found on ultrasound, but not on MRI.  If feasible, discussion of whether a liver biopsy may help can be considered.

2) By ultrasound, a normal spleen should measure < 13cm.

3) The size of the spleen has clearly increased over that time period.   I agree with the further imaging studies, and I would consider blood tests like a CBC and peripheral smear to exclude hematologic diseases.  

If the spleen continues to enlarge, removing it can be considered.

4) Viral disease can lead to chronic mouth ulcers.  I am not aware of a specific disease that connects this symptoms to those of your spleen.

5) With multiple MRIs performed, it's difficult to recommend further imaging scans.  Obtaining a hematology evaluation can be considered to explore other causes of the enlarged spleen.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[siobhanmh]

I should have added that both of the MRI were with and without contract and neither showed any focal liver mass to corospond to the hypoechoic one on the repeat u/s   is this common for the MRI not to detect such things?????

thanks