Isolate liver nodules in liver

[debi9218]

I am a 37 yo female, in good health, I just delivered a baby by c-sect 14 mo. ago, and stopped nursing about 2 months ago.  No birth control pills for several years.  Recently, I saw my PCP for some left flank pain, the u/a was neg. but pos. for blood (I've had that and been workup'd for it in the last 8 years, ? why), nonetheless, they sent me for CT urogram. They first caught a nodule on my right lung, but that was dx'd as a granuloma after some other tests, and yes, I did have a stone in both kidneys.  Then with the ABD U/S and CT with/without contrast, I was told that I have two nodules on my liver, one 2mm, the other 7mm, one in left and one on right lobes. Occasionally, I have dull pain RUQ, front to back, but have had this for three years and I was evaluated then with U/S and CT, and was told just "fatty liver." The dull achness actually decreased quite a bit after I stopped nursing my daughter.  Anyway,the CT report stated possible FNP, but could not exclude adenoma maglinancy.  My GI dr. drew CEA,CA19-9, CA-125, AFP, and coag's.  I am a nurse at the facility and have access to the lab work, just couldn't help looking up results, it was making me crazy. So I did and all the blood work was completly normal; tumor markers, LFT's and CBC, no high's or low's, just normal all the way around. Which made me feel better, but I am still concerned. I had an ABD MRI yesterday, won't know those results until next week.  I have a few questions.  Could the hormonal elevation during pregnancy and nursing contribute to these nodules?  Could they just be "fatty nodules," or would that pretty much be ruled out from U/S and CT?  I guess there is some hypervasularity to them.  And if this were CA, most likely wouldn't the markers be even slightly elevated?  If the MRI is inconclusive, is needle biospy probably next?  Or surgical resection?

[Kevin Pho, MD]

It is possible that hormonal changes can effect the nodules, but I would further investigate before attributing it to that.  Fatty nodules are a possibility, but the CT scan would be able to give that diagnosis.  

The tumor markers (specifically AFP for hepatocellular carcinoma) are not sensitive enough - only 41 to 65 percent in studies.  This means that over half are negative when cancer is present.  

The MRI should return several results for the liver lesion:

1) possible hemangioma - next step would be confirmation with a blood pool scan or observation if the MRI was specific enough.

2) simple cyst - repeat CT scan in 6 months.

3) abscess - antibiotics and draining.

4) cannot exclude malignancy - consider surgical resection.

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.
Medical Weblog:
kevinmd_b

[surgeon]

the most common explanation for such small nodules in an otherwise normal situation would be hemangiomas. They are quite common in the liver, and totally harmless. Sort of like a birthmark, but in the liver instead of on your skin. The MRI might help. Biopsy for something that small could be difficult, and surgical resection would be very unlikely to be recommended at this point.

[debi9218]

Is is possible then for hemangioma's to not be diagnosed soley on CT?

[surgeon]

Right: CT can't give all the info needed to be sure it's hemanigoma.