CT Finding of lesions

[Richies]

I am a 48-year old male.  I have never smoked and other than during my college days, I have never had more than a a glass or two of wine or beer occasionally.  I recently have had a number of neurological problems, including burning pain in feet and hands (diagnosed as possibly small fiber peripheral neuropathy), burning tongue, headaches and dizziness/lightheadedness.  EMG/NCV, brain MRI and many blood tests (including HIV) all normal.  Also no inner-ear problems.  Only adverse finding was that a lumbar puncture indicated high protein level of 88, so the neurologists are saying that something is wrong but they don't knonw what.  During the last few weeks my dizziness/unsteadiness has worsened and I have become very nauseous.  The neurologists wanted to rule out a paraneoplastic syndrome, so they did a CT scan of my chest, abdomen and pelvis.  The abdominal CT findings were as follows:  "Scattered small hypodense lesions within the liver are too small to characterize by any modality.  Otherwise the remaining liver parenchyma is unremarkable.  The gallbladder is normal in size.  The spleen, pancreas, adrenal glands and kidneys are normal in appearance.  The bowel is grossly unremarkable.  No free fluid or pathologically enlarged lymph nodes."  The pelvic findings were as follows:  "The rectal wall appears slightly thickened on axial images, which may be artifactual due to incomplete distension and/or tangenital imaging.  Clincial correlation advised.  No free fluid or pathologically enlarged lymph nodes."  (I have been tested for hepatitis as part of my blood work-up.)  My questions are:  (1) What might the liver finding of scattered small hypodense lesions possibly mean?  (2) Should there be other testing regarding the liver findings?  (3) What type of doctor should I see about the liver findings?  (4)  What about the rectal wall thickening - possible causes?  (5) Should there be other testing concerning the rectal wall?  (6) The neurologist is now advising a PET scan to further rule out a paraneoplastic syndrome.  Will the PET scan be helpful in determining if there is liver cancer?  (7) Could my neurological symptoms and/or nausea be caused by a liver problem?  (8) How would you recommend one pursue the nausea problem.  Thank you so much for taking the time to answer these many questions.  I am quite worried about my situation and want to get back to being "normal". SO many things seem to be going wrong with me!

[Kevin Pho, MD]

To answer your questions:
1) The lesions can be cysts, infection, or (less likely) some kind of neoplasm.  It suggests that they are so small that no modality can be of further use.  That being said, you can discuss whether an MRI can be of help.

2) If there is further concern about the liver, a biopsy can be considered for a more definitive diagnosis.

3) A hepatologist or liver specialist can be considered.

4) Thickening can be due to inflammatory bowel disease, infection, or colitis.  However, the report suggests it may be due to imaging factors ("tangential imaging") or the fact that the rectum was not distended fully.

5) A colonoscopy can be considered if there are GI symptoms.

6) The PET scan indeed will be helpful in ruling out cancer involving the liver.

7) Difficult to say.  If there is suggestion of cancer, it is possible this can lead to the neurological symptoms.

8) Nausea can be evaluated by a gastroenterologist.  Initial testing can include an upper endoscopy or upper GI series.

These questions and options can be discussed with your personal physician.

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