Abnormal CT abd/pelvis

For about the last 6 mos I've had intermittant LLQ discomfort.  A few weeks ago, in my normal state of health I began with a dull ache in my LLQ, which progressed to pressure in my entire pelvis, eventually extending to my rectum.  I was seen in the ED and evaluated with the impression that I had a cyst rupture.  I had an US at that time that noted fluid, and a cyst on my R side but nothing notable on my left.  This ER physician sent me home with a 'possible' diagnosis of a ruptured cyst.  Five days later the pain had not subsided and I went to my PCP, subsequently I had an Abd/pelvic CT with IV and po contrast.  The CT results are as follows: a 10x9 mm noncalcified nodule posterior in LLL.  (impression is that it is an AVM) due to proximity to a tortuous vessel (on this scan and a f/u CT of chest).  Liver had some min. central hepatic biliary prominence.  5mm nodule in gallbladder question gallstone vs polyp.  Spleen has multiple contiguous lesions either subcapsular in location in the left subdiaphragmatic region or possibly perpheral splenic lesions.Overall size is 30x18mm in demension, spleen otherwise has normal enhanced morphology.  Fluid in lesser sac anterior to pancreatic body.  Fluid does insinuate and surround celiac access.  Fluid as could arise from pancreatitis.  or could be related to gastric pathology or be associated with ascites.  Also small amount of intraperitoneal fluid in Right paracolic gutter and in Morrison's pouch.  Eval. of lower abd and pelvis demonstrates mod. amount of intraperitoneal fluid within pelvis.  Inguinal adenopathy is noted.  
I did f/u with a pelvic US about five days later that showed a significant amount of free fluid within cul de sac of indeterminate etiology.  Endometrial stripe thickness within norm limits at 5mm.  No significant adnexal masses noted.  Futher clinical evaluation recommended.  Like I said above a f/u CT also five days later showed the same pulm nodule and suggests it is an AVM. What could this all be?

[Annekathryn Goodman, M.D.]

Dear Christina,

The small nodule found in the lung may be not be important. As our imaging studies become better, we are picking up more and more small spots in the lungs, kidneys, liver, pancreas that are probably scars, small collections of benign bloods vessels, and so forth. The current approach is to repeat imaging studies in 3 to 6 months. If a spot seems to be growing or changing, that is a reason for a biopsy. Most of the time, nothing ever comes of these evaluations.

More importantly, you have fluid in your abdomen. A small amount of fluid may be normal especially after ovulation. But persistent fluid in many areas of the abdomen as you describe does not seem normal. It could be due to some kind of inflammatory process but some times fluid can be associated with malignancies.

I cannot make a diagnosis from your scan, however, you need to follow up with someone who worries about these things like I do.  I would suggest seeing a gyn oncologist or a further evaluation. With persistent pain and fluid in the abdomen, you should have a laparoscopy to look at your appendix , ovaries and lining of the abdomen.
please let us know what happens
take care