Liver Lesions

I am a 36 year old CA female with 3 gorgeous children and 2 step-children. I am a police dispatcher married to a police officer. My life is stressful! >:) I am 2 year status-post resection of a LARGE benign right axilla Scwhannoma nerve tumor. I recently, at my persistence, had a f/u with my cardiothoracic surgeon who believes that he has felt another lesion in my right axilla. After being told "they usually never grow back and it is rare for women to have this type of tumor", I was once again very scared. My surgeon ordered a mammogram (normal) and a breast and chest MRI w/ contrast. The chest MRI was basically normal, but the breast MRI shows a benign appearing cyst in my right axilla and also a new diagnosis of numerous liver lesions. Contradicting MRI's and I would have thought that the chest MRI would show more information? Upon speaking with my cardiothoracic surgeon, he assured me that he believed that the axillary lesion was benign and possibly scare tissue or a swollen lymph node. He asked numerous gastrointestinal questions regarding the liver lesions and suggested I f/u with a liver ultrasound before jumping to a CT w/ contrast. I do have numerous gastrointestinal problems and have put off having my upper endoscopy due to this current issue. I have had a previous upper endoscopy which was normal approximately 8 years ago. All liver functions tests done approximately a year ago were normal. On the ultrasound slip he put the diagnosis "r/o mets". I was a Certified Medical Assistant for over 10 years, so I know just enough to scare me! Suggestions?

[Kevin Pho, MD]

I agree with the workup thus far.  

The liver lesions can be further evaluated with the ultrasound.  A specific MRI of the abdomen should be done also to better image the lesions.

With the diagnosis of "r/o mets", your physician is considering the diagnosis of cancer.  The approach thus far would help evaluate these suspicions.

I would consider a GI referral to discuss the liver questions.

Followup with your personal physician is essential.

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, M.D.
kevinmd_

[ccheng8346]

Hello Dr. Pho,

I have a normal Alfa feto protein, ALT, HBV viral load at 17900 IU/ml and 41300 copies/ml. I go to liver ultrasound every year and this last exam shows two very small lesion. My doctor told  me not to worry and that for another check. I should go for CT scan. How reliable is Ultrasound in detecting lesion on the liver?

Thanks.

Carlos