RUQ Pain and Liver Spot

[tivodad]

This is a restatement of a situation I’d asked about earlier. I probably didn’t word the original very well. I had moderate to severe RUQ pain for about 2 months which finally subsided about 3-4 weeks ago but is not completely gone. I’ve had 2 CT scans (the 1st unprepped, the 2nd double contrasting), an ultra-sound, a lower GI, a chest x-ray, and blood work. The 2nd CT scan showed a 7mm x 14mm spot on the right lobe of my liver and a 6mm spot at the base of my right lung. The radiologist report gave 3 possibilities for the liver spots (1-cyst, 2-something I don’t remember, and 3-cancerous lesion).  I don’t recall any particular possibilities given for the small spot on my lung (btw, I have never smoked).  The two doctors I’ve been seeing, an IM (my regular doctor) and a GI (whom I was referred to for the RUQ problem), have indicated the spots are likely nothing to worry about and have asked that I wait until December to redo the CT scan.  My IM got the CT scan report from my GI and did ask that I have a chest x-ray to see if there were other lung spots. That x-ray was OK.
During the 2 months of abdominal pain, I felt as though I could have had some sort of an infection in my abdomen. I could lightly touch my abdomen and it felt as though I was rubbing sandpaper across my insides.  Also, the area at the bottom of my breastbone towards my right rib was very tender. Just touching it was painful and it still is.

1) What could be causing the tenderness at the base of my breastbone at my right rib?
2) I had an ultra-sound 1 month before the 2nd CT scan which showed all clear. Is it more likely the ultra-sound missed the liver spot or could the spot have appeared during the month between tests?  About 1 month prior to the ultra-sound, I had the 1st CT scan (no contrasting) as part of a kidney/gall stone protocol in the ER. No stones were found and there was no mention of a liver spot then either.
3) I figure the spots on my liver and lung are related since they are apparently in close proximity with each other and are in the same area as the pain. To me, this rules out the possibility of a cystic region and leaves infection or cancer as likely possibilities. Do you agree with that and more importantly, since the pain has greatly subsided, is it less likely the spots represent something as serious as cancer?
4) I don’t have any additional Dr. appts scheduled and they don’t expect to hear from me until December. Should I just sit and wait or should I pursue this further? For example, the CT scan was in early July.  Assuming my symptoms don’t get worse perhaps I should ask for a repeat scan in October/November - or just let it go?  Pursue another ultra-sound or a different test?

[Kevin Pho, MD]

To answer your questions:
1) Difficult to say.  It is possible that the lesions may be a factor.  Other possibilities can be musculoskeletal in nature - including pain from rib or overlying muscle.

2) Both scenarios are possible.  Without knowing exactly what the spot is, it is difficult to speculate.  

3) Again, I'm just speculating since I don't have the reports in front of me.  It is entirely possible that the lesions in both the lung and liver can be caused by either infection or cancer.  I would not rely on the degree of pain influencing what the diagnosis could be.

4) You can always consider another opinion.  An MRI as well as biopsy of the lesions can lead to a more definitive diagnosis.  

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