US results

[PaulaAnn]

Compared to US from 3/18/13

I had to get this US done at another hosp because dr canceled my appt and would be gone for 2 weeks so my March appt wouldnt be done till May...  so decided to get an order from him and get the US done in March....reason that they have the old report from 2013. the last report the hosp had.  I usually have them done at Cleveland Clinic.

I get an US every 6 mos for cirrhosis and I have had Hep B in the past but am now considered immune my Hep B tests have all turned out the way that they are supposed to DNA, Sag, etc since I am on xeljanz I have to have those tests every few months.

My US read:  

Rt Upper Quandrant US

Reason for exam (hcc check)

Clinical Indication  Hep B

compared to 3/18/13

Liver is diffusely heterogeneous in echotexture.  slightly lobulated contour. (this I know)  2 hypoechoic densities present demonstrating complex cystic characteristics measuring 2.2 cm and 1.9 cm...(have had since 2012)  Larger lesion corresponds to the single lesion present and on the prior imagine study with a new immediately adjacent hypoechoic lesion. A larger lesion the 2 lesions previously present has not increased in size but does demonstrate increasing complex characteristics. No biliary dilation seen.  common duct normal 3.8 mm.  gallbladder and pancreas unremarkable.  right kidney measures 8.7 cm in length.  without dilation.  

IMPRESSION:  Increasing complex cystic lesion in right lobe with new immediately adjacent cystic lesion.  findings prompt for non contrast and contrast enhanced CT for further characterization.  



I have had US's done every 6 mos at Cleveland Clinic ..last one in Sept with no issues that the hep noted.  Now he is thinking about sending me for an MRI.   he said this report is kind of confusing.   To me, for sure.

Saw my PCP today and he asked why not start with a ct scan?


In the midst of my moving all this...and the hep cant get me in till around May 8 because he will be on vacation.  

any ideas what this could be?  I also have rheum arth, etc etc etc   and am on xeljanz.    which can reactivate hep b

[PaulaAnn]

I had an MRI a few years ago to check my bile duct.  They didn't have earplugs I could wear because they wanted me to wear headphones to hear the tech tell me when to breath and hold.  They sure didn't help.  One time I thought they machine broke down.  sure wish there was a faster way of performing an MRI.  
I always thought if someone could invent a great easy colon prep and an MRI machine that is quick and still be precise, they would be a billionaire.

Kind of wondering why the hosp would use their own US from 2013 instead of getting a copy of the latest one from Cleveland to compare from 2015.  So obviously now Dr B doesn't said he cant make heads or tails from their report.  so he is doing the MRI since he didnt see what they saw from my US  6 mos ago at CC. so off a I go for the MRI.   He said he didnt think it was anything to worry about like cancer but that it was something we need to keep an eye on.

The radiologist also mentioned rib shadows in thin people..which I never heard of before....and I have fatty liver also.  

[PaulaAnn]

I appreciate that.  I never saw it worded like that before.  

Hope you are doing well.  

Have a nice evening Hector....

[PaulaAnn]

called Cleveland Clinic and made an appt for 5/6 for the MRI then see the hep at Cleveland Clinic on June 27th.   wish I knew how to relax during those MRI's.    

[HectorSF]

Lots of folks have "issues" with having MRIs. Pros: No radiation. Cons: They can be long, ~ 45 minutes for abdominal MRI with and without contrast and the vibration and noise are far from a soothing, relaxing experience.

I make sure the ear plugs are really fully in my ears not just part way. I want to hear as little as possible.

I also always keep my eyes closed before entering the tube and try to imagine I am lying on a nice beach with palm trees and white sand during the scans.

I've had countless dozens of MRIs over the past 8 years and many times I did have HCC which was being followed as I had various treatments. So I do understand worrying about scan results. Sometimes they can be life-changing. Luckily for most people with cirrhosis and those at risk from hepatitis B they are for surveillance only. Precautionary only. Used to catch any HCC in its early stages IF it should develop.

Hector

[PaulaAnn]

Thank you Hector...we now have a CC satellite hospital here in Akron and my hepatologist gave me a name of a gastro/hep affiliated with them that he knows is very good and that he went to school with.  His name is Dr Reynaldo Gacad.  He said it would be perfectly fine if I wanted to see him at Akron General.  

I get my US's done at CC every 6 mos along with bloodwork..the last one at CC in Sept 2015... except for this last time since my hep was going to be on vacation.  They compared this US with the one in 2013 (the last one I had there when I was dx'd).

I also wondered what the "clinical indication: Hepatitis B"   meant on the report.  

Thank you Hector.  

[HectorSF]

I am not familiar with these facilities but if your hepatologist feels they can perform your  US scans and follow up that should be fine.

"clinical indication" means the reason they are doing the scan. In your case they are monitoring your cirrhosis caused by Hepatitis B and the higher risk of developing HCC.

Hector

[HectorSF]

First, a US from 2013 is too old to be of any practical use in a cirrhotic patient. That is why we have them done every 3, 6 months to see the difference over that time period where changes (HCC, changes in liver size, etc.) can be seen.

Secondly, getting a US a month of two later or early than at exactly 6 months makes no difference in a person who has no indication of HCC.

Besides those points….

I would follow the reports recommendation.
“findings prompt for non contrast and contrast enhanced CT for further characterization” to assess “Increasing complex cystic lesion in right lobe with new immediately adjacent cystic lesion”.

Cyts are best and diagnosed using ultrasound (US) or with a CT scan. Liver cysts are thin-walled sacs filled with air, fluids, or semi-solid material. Liver cysts occur in approximately 5% of people. The majority of cysts are benign and have no impact on a person’s health.


Cleveland Clinic knows how to properly diagnose or rule out HCC other liver masses in a cirrhotic patients. Other hospitals may or may not. Certainly Cleveland Clinic is one of the most expert intuitions in liver disease in the entire country. Mixing scans from two different sources from years apart can only add confusion to everything. Cirrhosis of the liver is a highly complex disease and requires lots of resources for the best care. Other hospitals that don’t not liver transplant clinics are not at the same level of expertise in managing advanced liver disease.

Your GP is no expert in the diagnosis of liver masses.

My recommendation is to follow up with Cleveland Clinic (with the best liver experts in the country) and get another scan to rule out any concerns. Waiting a month or two will make no difference.

Good luck.
Hector