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Liver Lesion with elevated Liver Enzymes?

I am 32 years old and a type 2 diabetic. I had a blood test this past June showing elevated ALT (229) and AST (140), as well as slightly elevated hemoglobin and hematocrit  levels. The elevated liver enzymes prompted an ultrasound being ordered, the results of which showed fatty infiltration of the liver and a 6mm gall bladder polyp. I was sent to a surgeon who ordered another scan after 3 months to monitor the polyp for any growth.  i had the other scan last week which now shows a well circumsribed echogenic 1.3 cm lesion on my liver which does not demonstrate any blood flow. could this lesion be the cause of my elevated liver enzymes, hemoglobin and hematocrit levels and should i expect that my doctor will recommend more follow up? Or will a lesion of this size usually just require yet another scan in the future? should i be worried?
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Avatar universal
COMMUNITY LEADER
Have your doctors mentioned any diagnosis for your liver lesion yet? Or is it still considered to be indeterminate? The first thing that comes to mind is a focal, non-fatty lesion/region - given your previous diagnosis of fatty liver infiltration. Also, most malignancies require an ample blood supply, but your doctors state that yours does not demonstrate any blood flow. This is good.

Basically MR imaging is the best way to characterize focal liver lesions. It can be used to augment the data they already have via the US scans. They will use many different image sequence modes: T1- & T2-weighted, Diffusion, Opposed phase, Dynamic constrast enhanced, etc. Using the patterns that match you particular lesion's appearance, then they'll have their differential diagnosis.

Your liver enzyme levels are only mildly elevated. So the increases may simply be due to your fatty liver causing stress in your liver. You mention also being type 2 diabetic. Is your BMI very high? If your liver's fat content gets up to around 50% or more, then your liver cells will become very enlarged with the internal steatotic vacuoles, which injuries the hepatocytes and causes inflammation within the parenchyma.

The additional scanning of the polyp certainly makes sense. Remember that gallbladder cancer is an uncommon malignancy. But gallbladder polyps are relatively common - roughly 5 to 6% of the population has them. But polyps can occasionally become cancerous and should be dealt with in the proper fashion.

Using US to monitor your polyps is the standard protocol. In general, polyps less than 6 mm in size and that remain stable are considered benign and safe. Anything between 6 mm and 10 mm needs to be watched very closely (3 month intervals) and using a harmonic US procedure (if available). Polyps larger than 10 mm are considered very suspicious, and larger than 15 mm are considered dangerous. All polyps larger than 9 mm and of sessile shape (sorta a flat shape - without a stem) are also considered dangerous.

Given all that's going on, you'll want to keep seeing your doctors fairly often for the near future. Once things become "stable", the monitoring can happen at a more moderate pace.  I have many lesions myself so I've picked up quite a bit of knowledge along the way.

Hope all goes well and let us know how things are going.
Avatar universal
Thanks for the response!  My BMI at the time of the first US in June was 28 percent, although i have lost an additional 30 lbs since then. Interestingly b enough, blood labs from 2 years ago when my BMI was about 32 percent and my triglycerides were at 225 showed only a slight elevation in ALT and AST readings at 85 and 52. My triglycerides were normal at the time of the June v scan, however, did show not only the 6mm polyp, but also diffuse fatty infiltration of the liver as well as enlargement of the liver at 19.5 cm. The september scan shows a normal sized liver, as well as the polyp now at 7mm and the appearance of the 1.3cm lesion which wasnt there 3 months ago. Is it possible that it could have appeared in that short of a time? My primary doctor does not know about the lesion yet, as she didnt order the US, a surgeon did. She will know about it tomorrow evening when i walk the report into her. But should i expect that she will order further testing to check out the lesion? Or does it just have to be monitored 3 months from now for changes? 2nd report also states that the infiltration is preventing evaluation for focal lesions.
Avatar universal
COMMUNITY LEADER
Yep, liver enzymes are tricky to predict for sure. Small GI infections or other inflammations can cause transient elevations in the numbers. But I'd say that your noted decrease your liver's overall size is a good indication that you've improved your health. Good job and keep it up!

Something I should have mentioned previously is that focal liver lesions, found in patients without advanced liver disease and fibrosis, are almost always benign in nature, over 90%. So you doctor will likely know this and it will factor into the decision whether to do something now or wait for a followup scan in 3 to 6 months.

If it were me, I'd push to have a MRI done now rather than waiting - if they cannot give you a confident diagnosis by using the recent US data along with your blood work. I know that it is likely benign (from the previous paragraph), but knowing is a lot easier than not knowing. And yes, the lesion may have popped up within the 3 months, or it simply was missed by being just small enough to escape detection.

Bu using the MR imaging technology, the radiologists will be able to filter out the obscuring fatty infiltration. Also, by using the in-phase vs out-of-phase T1-weighted imaging sequences, they will be able to quantify exactly how much fat is in your liver (likely a low-content due to the good health work you've been doing). So again, MRI is the best way in diagnosing your new liver lesion.

Let know how you are doing!
Avatar universal
Thank you so much! I will keep everyone posted!
Avatar universal
Went to my regular dr. Tonight and she ordered MRI with contrast.  She also wants my gall bladder out, and i see the surgeon next week. Got a bunch of blood work done this morning as well.
Avatar universal
COMMUNITY LEADER
Very good, your doctor is aggressive and staying on top of things. I've had more than a dozen liver MRI's so I should be able to help you understand anything your doctor leaves uncertain.

And removing the gallbladder due to suspicious looking polyps is standard procedure. It is simply a safer way to extract everything, all encapsulated so there is no chance of spilling or leaking cancerous cells. If they tried to surgically remove individual polyps, spreading cancer is more likely, not good of course.

Take care.
Avatar universal
So i got my MRI - the liver lesion was a confirmed hemangioma, so all is well! In addition, no fatty infiltration of the liver is present and my liver enymes are now back to normal- first time in over 10 years! The only other issue is that my hemoglobin, hematocrit, rbc, and wbc is high, which she will undoubtedly pursue. I also see the surgeon tomorrow for the gall bladder.
Avatar universal
COMMUNITY LEADER
Excellent news!
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