Upper Abdominal Discomfort

[azone]

I am 40 and have had abdominal discomfort/light pain on the left side for approx. 8 months. Mostly in the upper abdomen (under rib) but it moves around (sometimes as low as belly button but still on left side). Saw my family doctor 3 times, a urologist and a GI doctor. The discomfort/pain is not constant, sometimes lasts several hours, sometimes all day. Initially also had lower back pain on left side and left testicular pain.The urologist found nothing, the GI doctor said it was IBS. I had two ultrasounds (the second was a full abdominal ultrasound), both found the kidneys were normal. Then I had an abdominal CT at the recommendation of my family doctor (because the ultrasound could not fully see the pancreas). The CT scan found a 6mm exophytic cyst arising from the inferior aspect of the left kidney and "a 3mm low attenuation lesion in the upper pole of the left kidney too small to accurately characterize."

My family doctor wasn't concerned about these findings . My questions are:

1) What exactly is a "low-attenuation lesion" and is it something I should get evaluated further?
2) Would the "upper pole" location be of any significance.
3) Could an exophytic cyst (or the lesion) be the cause of pain/discomfort in the upper left abdomen?
4) Would it be normal for these to not show up on an ultrasound.

Thanks in advance for your response.

[azone]

Thanks Dr. Liroff, your comments are very helpful.

azone

[Stephen Liroff, MD]

A low attenuation lesion is one that does not appear to have as much  signal intensity as the surrounding tissue. In kidneys it is typical of  cysts and areas with high fat content (such as angiomyolipomas…usually benign growths). Thus, these areas usually represent non-cancerous lesions.
The location of this upper pole finding is not significant.
The pain is not likely to be due to the cyst. It could be punctured and the fluid drained to see if your symptoms changed, but I doubt that it will change your discomfort.
Usually an ultrasound is quite sensitive to picking up renal cysts. This study is quite operator dependent and on that basis a lesion can be missed. Also, an abdominal ultrasound is usually done from the front only and the kidneys are located in the back. There is a lot of tissue for the sound waves to get through in order to see the kidneys well. A dedicated renal ultrasound (which is done from the back) would be more reliable in finding a cyst. The CT scan is superb at demonstrating even very meaningless, small abnormalities in the kidneys that may not be seen on any of our other tests.
Maybe your  pain is due to a "pinched nerve" from your spine. I think that a good physical exam of your back may be helpful if nothing else is found.
S.A.Liroff, M.D.