If CT unremarkable and still concerned, consider MRI abdomen with and without contrast. For evaluation of liver, US is inferior and is unlikely to show anything the CT did not see.
“ What Causes Gynecomastia?
cirrhosis of the liver,
chronic kidney failure,
disorders of the testes (male sex organs) including infection, trauma, or inborn disorders,
anti-androgen treatments for prostate cancer, and.
“ The causes of the gynecomastia can result as a side effect of numerous medications and drugs of abuse, for example:
Corticosteroids and anabolic steroids.
Herbals like dong quai, tea tree oil, and lavender.
Opioids (narcotic drugs)
Estrogen (including those in soy products)
Hepatic encephalopathy is not necessarily associated with blood ammonia levels. HE is diagnosed by symptoms. Tinnitus and face numbness are not symptoms of HE. Also , HE from liver disease is a symptom of end stage liver disease and cirrhosis . Undoubtedly, you would have other indications of advanced liver disease HE is not usually the first presentation. I’ve had cirrhosis for 12 years. I have a low platelet count due to portal hypertension and lower leg edema. My ultrasounds show an enlarged liver and spleen. My liver shows as having a coarsened echotexture consistent with cirrhosis. I was diagnosed in Jan 2008 with liver biopsy after being infected with hep c for 30 years.
Do you have a reason to believe you have advanced liver disease?
“ A wide range of diseases and conditions can damage the liver and lead to cirrhosis.
Some causes include:
Chronic alcohol abuse
Chronic viral hepatitis (hepatitis B, C and D)
Fat accumulating in the liver (nonalcoholic fatty liver disease)
Iron buildup in the body (hemochromatosis)
Copper accumulated in the liver (Wilson's disease)
Poorly formed bile ducts (biliary atresia)
Alpha-1 antitrypsin deficiency
Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)
Genetic digestive disorder (Alagille syndrome)
Liver disease caused by your body's immune system (autoimmune hepatitis)
Destruction of the bile ducts (primary biliary cirrhosis)
Hardening and scarring of the bile ducts (primary sclerosing cholangitis
Infection, such as syphilis or brucellosis
Medications, including methotrexate or isoniazid
Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis.
Being overweight. Being obese increases your risk of conditions that may lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it's one of the world's leading causes of liver disease.”
If you don’t have liver disease you cannot have Gynecomastia or HE from liver disease.
Best of luck to you see your doctor for proper diagnosis.