Abdominal Pain - Liver spots

[tivodad]

I am a 49yo, 212lb, 6’1”, non-smoking male in what I thought was fairly good shape. Three months ago in May, I developed pain in upper right quadrant extending from area just under the breastbone to a few inches to the right and under the rib. Early on, the pain extended around the right side and also radiated through to the back. I also experienced some pain at the right kidney and lower back.  Pain was severe at times. An emergency unprepped CT scan was performed to look for gall stones or kidney stones but was clear. Lower and kidney pain subsided after a few days but moderate upper and upper right pain persisted. Blood and urine tests were normal with a slightly high (1.1) bilirubin level.  A lower GI was performed which revealed numerous diverticuli in right, left, and transversal colon, but no polyps or masses. A RUQ ultrasound was performed and was clear. A double contrast CT scan was performed (1 month after the ultra sound) which found a 7mm x 14mm spot on the right lobe of my liver and a 6mm spot on the base of my right lung. My GI ruled out any problems with the pancreas based on this scan. A subsequent chest x-ray 4 weeks later showed no lung spots although I wonder if it could have shown a 6mm spot anyway. Pain has subsided considerably (but lasted 2 months) with only slight pain in the upper right area for the past 3-4 weeks. Appetite has remained good and stools are dk to lt brown ranging from soft to well formed.  During this time I took Protonix 40mg once a day and noticed that some of the upper pain subsided if I would eat a snack every 3-4 hours. After a few weeks I noticed less pain even if I did not eat and then I took myself off of Protonix without incident 2 weeks ago. I’ve told my doctors that all pain is gone but subsequently some vague and intermittent pain has returned in the upper right area which I have not reported. Both my GI and IM doctors believe the spots are not of concern but want to follow up with another CT scan in December.  Since the spots on my liver and lung appear to be in the exact area that I was (am) having pain, I wonder if waiting 4 more months to look at this again is a good idea.  What could these spots be?

[Kevin Pho, MD]

Difficult to say without evaluation.  "Spots" can correspond to cancer, cysts, benign lesions, or infection.  

Under the radiologist's impression should be a list of possibilities that the radiologist think may be the case.  If there was suspicion for cancer, more urgent testing would have been recommended.  

The fact that only a follow-up CT scan was recommended suggests a more benign lesion.  

You may want to discuss the possibilities with your personal physician, or obtain a copy of the CT scan results and bring it to another physician for a second opinion.

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.
http://www.straightfromthedoc.com