your opinion

[chad115]

This started 3 months ago, Knee pain that started at night worst pain ever / I went to orthopedic and he drew fluid said it was gout . Shortly after mild right side back pain that seemed to make my knee worse.
Went to my Dr at home liver enzymes and cholesterol up . Suggested a low fat diet prescribed anti inflammatories .
Pain in back got worse so went to Mayo Clinic , Ct scan reveled a horseshoe lesion liver . Dr said in his opinion nothing to worry about come back in 3 months . Neg for hep A B C . Back pain starts at upper back but can move to the front and sometimes sharp pains in the side,  Seems to be worse while driving in the car. Any opinion where to go from here, I mean I thought the mayo was it but I wasn't impressed and why wouldn't he think the spot he found on the ct was serious enough to run the other tests, Any Ideas would help gout has never completely went away in knee

[chad115]

Why would the Dr think the spot on the ct wasnt serious and ask me to come back in 3 months?

[Kevin Pho, MD]

I agree with the CT scan.  Depending on how elevated the liver enzymes are, a liver biopsy would give a more definitive liver diagnosis.  

Further evaluation of the biliary tree with an MRCP can be considered if there is suspicion of a biliary duct stone.

If the GI route is non-revealing, you can consider a musculoskeletal cause.  A referral to a physiatrist (rehabilitation MD) or physical therapy can be considered.  

Imaging the kidneys with an ultrasound can also be done to exclude a lesion there, or a kidney stone.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com