Confusing liver focus

[oona]

Hello, I am a 29 year old women with a confusing liver issue. When I was seventeen, I was told that I had Hepatitis C. Flash forward ten years and was told by a Liver Specialist that I did not have any viral load on my HCV RNA test, hence I did not have Hep C. This fall / winter I have been very ill. I have been in bed for practically four months. In October my nurse practitioner sent me for an ultrasound where it was noted that I had what appeared to be a 3.4 cm cavernous hemangioma. My follow up CT scan (with and without contrast) was done this month and the radiologist listed it as "probable focal fatty infiltration" 4 cm. I am confused by this lack of definitive diagnosis. I also have slightly elevated (fluctuating) bilirubin and digestive trouble (problems with eating/bowel movements for over four years now). The only other significant finding has been an elevated ANA test with two patterns speckled and homogeneous 1:160. I am now around 100 lbs. (down from 110-115) and looking for answers. If anyone has any advice ideas about what this issue could be, please let me know. Thank you so much in advance.  

[Thomas D Schiano, MD]

if the HCV-PCR is (-) it means that you were probably exposed to HCV but do not have the infection.  Rarely there are false (+) HCV Ab that can be present in the setting of inflammatory disorders.  I do not think that your symptoms are related to the liver per se but I am concerned about your weight loss.  I think you should have further testing, including celiac disease serologies and maybe seeing a rheumatologist.  I hope you feel better.

[Thomas D Schiano, MD]

repeating the scan is the best option for peace of mind.  you may need to have the endoscopy repeated.

[oona]

I had an endoscopy in 2006 which was clear. The reason I am worried about this focus is that, I know it's rare, but my aunt had primary liver cancer when she was 23. That was 30 years ago, it was the size of a softball, but she survived. The lack of concrete definition is concerning me, in light of my family history, and my previous exposure to Hep C. Although, I suppose that if there was any pressing questions regarding the US or CT, the radiologists would have noted the matter as urgent, is that true?  

I just wonder what this could be, and why someone my size would have focal fatty infiltration, or something similar, without history of diabetes, etc. Maybe it's just a fluke?  

[Thomas D Schiano, MD]

i am not ovferly concerned about the characteristsics from the report about the lesion.  A CT scan witnh a special contrast agent named eovist could also be performed.  If they are doing a colonoscopy, an upper endoscopy should also be performed at the same time.

[bournemouth]

you can make liver biopsy to find out

[oona]

Dear Doctor Schiano,

Thank you for responding. I am also concerned about the weight loss. I did test negative twice on the celiacs disease test. I have a colonoscopy scheduled for February 1.

My main concern is diagnosing this focus on my liver. Although a rheumatologist seems in order as well. I am still trying to get a referral.

This focus seems large to me, 4 cm, having not shown up on any previous ultrasound over the last year. It's still not diagnosed definitively and I'm worried that it could be cancerous (because of how sick I have been feeling).

The first test says "a solitary echogenic focus appears on the left lobe of the liver with appearances most likely representing a cavernous hemangioma" and my follow up CT (w/ & w/o contrast) indicated "probable focal fatty infiltration located adjacent to the falciform ligament, it does have a regular shape". Follow-up MRI was recommended, but I was very claustrophobic and unable to go through the test.

Does this focus sound concerning to you? Are there any other tests that could be done to diagnose this thing definitely? What could it be?

Thank you again and happy holidays.