ultrasound test results

[Javi1962]

can anyone please help me interpret this?

Findings: There is a diffuse coarsened echogenicity of the hepatic parenchyma, with an attinuation of the ultrasound beam. thiere is no definite focal lesion identified and the liver is upper normal in size. there is no possibly volume averaging of the splenic hilum.
The gallbladder is mildly contracted, and there is an echogenicity 12mm structure with acoustical shadowing within the gallbladder. There is no definite wall thickening. The commin duct measures 4 mm in AP diameter, which is normal.

the aorta was not visualized. The ccphalad portion of the inferior vena vava appears patent.

IMPRESSION:
DIFFUSE COARSENED ECHOGENICITY OF THE HEPATIC PARENCHYMA, LIKELY DUE TO UNDERLYING HEPATIC PARENCHYMAL DISEASE OR STEATOSIS. THERE IS NO DEFINITE FOCAL LESION IDENTIFIED.

[Javi1962]

yah thats my next step is to do liver biopsy, im not sure why dont doctors go straight for biopsy why waste time with ultrasound, everyone says that ct scan or mri is better then ultrasound, anyway that is going to be my next step, hopefully it all comes out well

[nygirl7]

Sorry just read your last post as I hit send so it's a dumb question - that's what I get for reading early in the morning before my coffee.
Don't be worried about the biopsy........it's not nearly as bad as it sounds like it will be!

[nygirl7]

Javi did you get your biopsy yet or is this just the pre-ultrasound portion of testing?  That test will determine how much fibrosis you have and what stage and grade of liver damage you are.

It is a great thing though not to have any tumors :)

[Javi1962]

thanks for the advise sounds good if I can do both GB removal and biopsy at same time.

[robo229]

Hopefully, you'll never develop a liver lesion.  I would not conclude that developing one is the next logical step.  Biopsy will tell where you're at with progression of liver disease.  

I had my GB removed, but was symptomatic.  I see many many gallstones that are left alone if the patient is asymptomatic.  Really depends on symptoms and why your Dr. advises cholecystectomy.  You can have liver biopsy during cholecystectomy thus avoiding 2 procedures.  The biopsy will help in deciding if and when to treat.

Current treatment is tough.  I have tremendous respect for anyone who tries.  My experience was awful and I'm currently deciding my next plan of action with my hepatologist.

Good luck!

Best,
Robo

[Javi1962]

thanks for that info, my GI this morning told me i had excessive fatty tissue on liver and he said NO cirrhossis and of course the no focal lesion for now, but he made it sound that the next step after the fatty stage on my liver would be the lesions?
he also said I have a gallbladder stone, it's small but will need to be removed before starting treatment. I guess my next step here is a liver biopsy hope that turns out ok, I really would love to wait for future treatment if I can, it sounds from everything im reading that the treatment can be pretty tuff to go through with all the side effects.

[robo229]

Sorry hit post comment too soon.

It is difficult to distinguish why this is by US.  Could be fatty infiltration (steatosis) as suggested in the report.  Early changes of cirrhosis are hard to distinguish from fatty infiltration esp on US, thus the need for biopsy.There is a long list of reasons for fatty infiltration.  HCV can do it, alcoholism, obesity, diabetes, certain medications and the list goes on and on.  
Having a liver at the upper limit of normal in size is nothing to worry about (still w/in normal range).The 12 mm shadowing structure in the GB is your gallstone.  The GB being contracted may indicate you were not fasting prior to the study (tsk tsk).  Do you have symptoms of GB disease?

Normal Common Bile duct diameter is 6 mm for an adult your age.

"No focal lesion".  THAT IS A VERY GOOD THING.  Also no mention of findings associated with portal hypertension.  No ascites.  Overall, this is a good result.  Keep in mind US is a good imaging tool but pales in comparison to CT or MRI.

Hope you find this info helpful.  Sorry if I ran too long.

Good Luck to you.

[robo229]

Javi,  Let me see if I can help.  I am a radiologist with HCV.

The language of ultrasound(US) is different than other imaging modalities because images are generated using sound.  It is a different way to describe the grayscale.

grayscale:
Black-------------->dark------------>intermediate----> bright-----------> white

Ultrasound description:
Anechoic--> hypoechoic--> homogeniously intermediate echogenicity--->
hyperechoic/echogenic

Water tends to be anechoic, normal tissue is intermediate, fat is echogenic.  This has to do with the way tissues interact with US waves and is called acoustic impedance. (sorry for the techno jargon)

When the liver loses its homogeneous smooth echogenicity, it indicates some hepatic abnormality but is very nonspecific.

The coarsened description likely means the liver is increased in echogenicity.  The more echogenic the harder it is for sound to travel through the tissue.  It is attenuated.

[Javi1962]

to make the day even brighter the doctor said I have a gallbladder stone and need to get this removed before starting treatment

[mikesimon]

portal vein (if that is duct they are referring to)   - I believe that reference was to the common bile duct which appeared normal.

[newleaf09]

Not too familiar with their language, but it actually sounds pretty good (though ultrasounds don't tell much).  Sounds like, in a nutshell, that there may be fat, they can't see any lesions (obvious cysts or tumors) , liver size a little large but still within normal range, portal vein (if that is duct they are referring to) not enlarged to indicate blockage and increased pressure.  

I wouldn't get too excited.  Neither my ultrasound or MRI showed cirrhosis but that's what the biopsy came up with.  I do sometimes wonder if the cirrhosis biopsy diagnosis was accurate, though.