Poorly defined, hypodense, left medial segment liver lesion - do I need to worry?

History:  34 year old male with IBS abdominal cramping/spasm pain.

Tests:  I went in for a GI Barium CT scan for my IBS issues.  GI CT findings were normal, with no obstructions, but they found a lesion in liver.  They think it is a hemangioma, so then send me to do an ultrasound to confirm, but the ultrasound is less clear, and states that it does not appear typical of hemangioma, but possibly an atypical hemangioma in setting of fatty liver.  However, it is not definitive that it is this, so, now I don't know if I need to worry or not.  

Also the ultra sound report seems to refer to a lesion on the left lobe of size 2.8x2.0x2.0cm vs one on the right lobe of 13x11mm on the CT scan, so I'm confused why the location of the lesion changed as well as the size of the lobe between the two reports.  Or did they mess up the measurement and description in the report?  (The reports are pasted at the bottom).

I also had a lot of blood tests done.  I'm still waiting for AFP result to come in.  The remainder of the blood test results from 9/22/2010 appear to be in normal range except my ALT which was 48, outside the lab range upper limit of 36; this compares with a March 2010 ALT test value of 29, which was within the lab range upper limit of 36.

The doctor's recommended course of action so far (pending remaining lab results) is to follow up in 3 months with another CT, presumably to make sure everything is stable and there is no growth.  Is there anything else I can do except wait 3 months to see if there is no growth?  

It just seems that they can't definitively state it is a hemangioma, so the only thing they can do is just do a CT scan again in a few months to make sure there is no growth.  However, what happens if it is cancerous, then I've lost 3 months time where we could be trying to do something about it.  

Do I need to worry?  Is this an appropriate course of action, to just wait 3 months for a new CT scan?  Or am I worrying for nothing?  i.e., does everything here seem most probably consistent with an atypical hemangioma in setting of fatty liver?  I just don't know what to do.  The AFP test has not yet come back but all the other tests came back...I'm worried they are delaying for some reason unless that test takes longer.  Should my course of action change if AFP test which is 60% sensitive comes out abnormal?  Should course of action stay the same if AFP test is normal, (but my ALT was high at 48 relative to lab upper bound of 36)?

The report results are stated below:

**************9/7/2010 CT REPORT ***********
**History**:  34 year old male with long-standing cramping abdominal pain that is most consistent with IBS. Previous evaluation showed negative colonoscopy (although a sharp angulation was noted in sigmoid colon).  Physical exam is normal.  Please assess for radiologic evidence of bowel obstruction/hernia.

**Findings**:

Following oral and intravenous contrast administration, axial images are obtained through the abdomen and pelvis.

No comparison.  Bases are unremarkable.  Heart size is normal.  No abdominal hernia is identified.

A 13x11 mm low density lesion in periphery of the inferior aspect of the right lobe of the liver is nonspecific but compatible with a hemangioma.  A 4mm low attenuation structure in the posterior right lobe of the liver is too small to characterize but compatible with a tiny simple cysts.  No biliary ductal dilatation.  Gallbladder unremarkable.  Spleen, adrenals, kidneys, pancreas appear normal.  No ascites.  

Small bowel is normal in caliber without evidence of obstruction.  Upper rectum is collapsed.  Colon is unremarkable.  No inflammatory changes are seen adjacent to the colon or rectum.

***IMPRESSION**:  No abdominal hernia or bowel obstruction.  

Small area of low attenuation in inferior right lobe of the liver, non specific but compatible with a hemangioma.  Consider confirmation of this impression with focus liver ultrasound.



************9/14/2010 ULTRASOUND REPORT************:
**HISTORY**:
Abnormality seen on CT may represent hemangioma.

**FINDINGS **:
A limited abdominal sonogram with images of liver and biliary tree was performed.

There is a poorly defined hypoechoic mass in the left medial lobe of the liver, difficult to accurately measure but approximately 2.8 x 2.0 x 2.0 cm.  By my measurements on CT, it is unchanged in size since 9/7/10.  The liver overall shows moderate increased echogenicity, without biliary ductal dilatation.  Regions of fatty sparing are seen around the gallbladder fossa.  The irregular lesion is not typical of a hemangioma but may appear atypical in a fatty liver setting.

The smaller right posterior segment lesion described on CT is not well appreciated by sonogram, probably due to technical limitation from fatty infiltration.  On CT, this smaller lesion was more typical of hemangioma.  The 4 mm tiny lesion is not appreciated sonographically.

There is normal hepatopetal portal venous flow.  No focal tenderness or ascites is present.  The gallbladder and extrahepatic ducts are normal.

**IMPRESSION **:
1. Poorly defined, hypodense, left medial segment liver lesion, not typical of an hemangioma.  More convincing imaging on CT and suspect atypical hemangioma in setting of fatty liver.  If conservative management is chosen, short interval followup is recommended 2-3 months.
2. Moderate fatty liver.  Fatty sparing around gallbladder fossa.
3. Posterior segment and tiny additional lesion seen on CT are not appreciated on sonogram, likely due to technical difficulties, also with limited depth penetration due to fatty liver.


***********************BLOOD TEST RESULTS****************************

***9/3/2010 tests**:

Component         Your Value Standard Range
C-REACTIVE PROTEIN,SER,QL 0.1 <0.5-  mg/dL

Component         Your Value Standard Range
ESR 6 0-15 mm/Hr

Component         Your Value Standard Range
ALBUMIN 4.8 3.3-4.7 g/dL

Component         Your Value Standard Range
CALCIUM 9.9 8.5-10.3 mg/dL

Component         Your Value Standard Range
CREATININE 0.85 60 >60-  mL/min
GLOMERULAR FILTRATION RATE - AFRICAN AMERICAN >60 >60-  mL/min
COMMENT, GLOMERULAR FILTRATION RATE SEE NOTE



***********9/22/2010 tests************:

Component         Your Value Standard Range
ALKALINE PHOSPHATASE 72 37-117 U/L

Component         Your Value Standard Range
BILIRUBIN, TOTAL 0.5 0.2-1.2 mg/dL


Component         Your Value Standard Range
ALT 48 <36-  U/L
*****My prior ALT test value was 29 in March 2010, compared to the 48 here for ALT on Sept 22, 2010


Component         Your Value Standard Range
AST 22 10-40 U/L
******My prior AST test value was 18 on March 2010, compared to the 22 here for AST on Sept 22, 2010


Component         Your Value Standard Range
NUCLEAR AB,SER,QL NEGATIVE NEGATIVE-  

Component         Your Value Standard Range
IGG 1290 600-1600 mg/dL




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