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Riedel's lobe? Please help.
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Riedel's lobe? Please help.

I recently had a CT scan of my abdomen. My PCP ordered it because of elevated pancreatic amylase (222, then 130 a week later), slightly elevated ALT, elevated B12 (1200), nausea, extreme fatigue and thirst, and dizziness.
I got a call from the office that everything was "normal" on the CT scan. While glad to hear that, I was a bit concerned because I reviewed the scan myself and discovered that the right lobe of my liver extended 5.5cm below the lowest point of my 12th rib (abnormal as I understand), and my right kidney is 4.5 cm below my left (normal as I understand is 1-2cm).
I contacted the radiologist about his report and pointed these out. He then re-looked at the scans and said "it looks like you have Reidel's lobe, an congenital abnormality. I asked about the kidney and he said that too was congenital.
A few questions: 1)Isn't Reidels lobe rare? **Is it possible I have inflammation of the liver causing it to be displaced downward?** The lobe does not look "toungelike" at all - it merely sits low. I am concerned about this because of my elevated amylase and slight elevation of ALT, along with high B12. 2)Isn't a kindey that sits that low, 4.5cm below the other and only 1cm above my iliac crest, technically a floating kidney? 3)**Shouldn't these both be investigated further?** and lastly, 4)I'm upset that the radiologist did not include either of these details on my report. I suspect that he did not thoroughly review my scans and didn't see them until I mentioned them and he re-looked at them. Is it not standard practice to mention both the "Reidel's lobe" and low kidney on the report?
I do not feel well and would like an answer to what is going on with me so I can obtain treatment. I'm a pre-med student (change of career) and this overwhelming fatigue is interfering with my classes and part time job at the hospital. I'll be crushed if I can't make it into/through med school because of these health problems. I am upset at the radiologists lack of detail in documenting what he calls a congenital defect and my hunch that he didn't thoroughly inspect my scan (I'm not confident in his re-nig diagnosis of Reidels after prompting by my phone-call), and that my PCP's nurse called after the scan with a "everything looks normal, call if any more problems". My symptoms didn't magically disappear after the CT, they are still here, and everything does not seem normal.
If this helps for background info - I am a 29 years old female, exercise regularly with healthy diet, drink once a month or so, non-smoker, low-to-average BMI. Serum glucose runs around 77, C-peptide mid-range lab value. Just the overwhelming fatigue, body aches, periodic dizziness, thirst, periodic nausea, and joint pains.
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Avatar_m_tn
Wow, our stories are VERY similar! On CT the right tip of my liver is only 1 cm from the top of my hip bone - it extends 4" below my lowest rib on the right. I have a lot of pain and burning in my right flank, difficulty eating, weight loss, lower right back pain, etc. It hurts when I stand and turn from side to side, but sitting is the absolute WORST!!!  The pain is relieved by lying down.  Fatigue and pelvic pain are also very long-standing. My CT has been reviewed by 2 radiologists and they agree the size and position of my liver is normal. There was no mention of "Riedel's lobe" by either of them, but that's the only thing I can find in all my mad Googling (LOL) that would explain such anatomy.

Coincidentally, I had an ultrasound the same day at the same facility. The radiologist who looked at the U/S described "enlarged pelvic varices" and "pelvic venous insufficiency" and asked in the report "Please correlate clinically." I've been referred to an OB/GYN and scheduled an appointment to explore the possibility Pelvic Congestion Syndrome (VERY high likelihood at this point). PCS makes a great deal of sense and explains all of my symptoms EXCEPT the right flank/abdomen/back pain.  I kind of wonder if this lobe of liver drooping into my abdomen is compressing other anatomy below it, causing or contributing to the PCS.

Ironically, although the varicose veins in my pelvis on CT are all too obvious to me, neither of the two radiologists who looked at my CT made note of them. The radiologist who reviewed my ultrasound did not review the CT. I bet if he did, he would have been looking for the varices, and he would have found them. Other than that, all that was found was a 11mm paraovarian cyst (identified on U/S but not CT), a 14mm "probable" cavernous hemangioma on my liver (by CT), a small cyst on the lower pole of my left kidney (CT), and an 11mm uterine fibroid (seen on U/S). Mostly benign stuff that I can gladly shrug off.

I've been dealing with pelvic/abdominal pain and severe bloating (every day, regardless of what I eat -- I get uncomfortably distended from drinking a glass of water!) issues for >8 years.  I have had almost every GI lab test and imaging study you can think of. The enlarged pelvic varices and this liver thing are the first solid clues I've had in all these years. I'm pretty much disgusted with doctors.  I've been treated like a hypochondriac, told it's just depression and to eat more fiber. WHAT? Eat more fiber? I don't know how that is possible. I'm a vegetarian, most everything I eat is loaded with fiber!  :)

The only other clue was that all three times I had my pancreatic enzyme levels tested, both the amylase and lipase consistently came back abnormally high, but not high enough for the docs to care.  After awhile I got disheartened and just gave up.  I decided to stop looking for answers and just deal with the pain without complaint... eat well, exercise when I feel up to it  (which I can only do in the morning, the pain is too severe in the afternoon/evening), keep emotional stress to a minimum, avoid stressing my body with OTC and other drugs, completely abstain from alcohol, etc...

Now, finally a solid clue about the pelvic pain (PCS)... But for some reason those radiologists don't seem to think my liver could have anything to do with my right flank pain.  Yeah, I am pretty much disgusted.  ;)

Please post again if you should find anything more out about your droopy liver lobe and/or the cause of your grief. I will do the same.  :)
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Avatar_m_tn
Oh, just some additional background, I also have chronic fatigue (mostly afternoon fatigue, my energy is highest in the morning), a diagnosis of Fibromyalgia for wide-spread muscle pain, and Hashimoto's thyroiditis - hypothyroidism controlled with Armour Thyroid Rx.
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Avatar_n_tn
have you heard of hemachromatosis? This is rare and not too many people know about it. Your parents may be carriers and have no symptoms. Have a blood test called GGT done along with serum ferritin. Good luck.
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