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Avatar universal

Nonspecific Abnormal Findings on Radiological please help

2/2011 I had chest pain under my breast near the heart which felt like high rib pain. I was on the birth control pill at that time (since discontinued them) and my Endo.(hypothyroidism) recommended that I see my PCP. for an x-ray. I got the x-ray and PCP ordered CT/CT Angio Chest I was having Dyspnea. Everything came back OK except: There is an 18mm low attenuation lesion in the right lobe of the liver with peripheral enhancement. The pattern is suggestive of a hemangioma. Right lobe liver lesion question hemangioma. A follow-up MRI is suggested to confirm this.
I did not want to have the injection for the MRI because I read about NSF and I'm scared about the gadolinium even though I currently have no kidney issues.  I asked my primary Dr. if there were any other imaging tests or do I absolutely need the MRI. Two days after the CT scan we did an ultrasound report is below:

Limited abdominal ultrasound
HISTORY: Chest CT performed reported 18-mm peripheral enhancing lesioin right lobe of liver felt likely to represent hemangioma but not completely evaluated on the study of the chest by report.
A rounded well circumscribed mass with sharply demarcated margins is present in the right lobe of the liver. The mass is hyperechoic to the surrounding hepatic parenchyma and measures approximately 1.8 cm in maximal dimension. No other hepatic lesions are seen.

CONCLUSION: Well circumscribed hyperechoic mass right lobe of the liver measuing 18mm in maximal dimension. The appearance is typical for hemangioma. A follow-up ultrasound could be obtained in 6 months time to document ongoing stability.----

I have ultrasound coming up I'm wondering if I should do the MRI or is having the ultrasound to monitor this  lesion a safe option? Should I  seek a second opinion? My last office visit with my primary Dr. when asked if it was thought to be a cancerous lesion I was told they can't rule out cancer at this time but it's probably not. Not sure what I should do at this point.
9 Responses
517301 tn?1229801385
MEDICAL PROFESSIONAL
i think that this is a hemangioma from what you describe.  the test of choice is a contrast MRI--I am not aware frankly of anyone developing (extremely rare overall)NSF with having normal renal function.  for peace of mind i would encourage you to get the MRI.
Avatar universal
Thank you for taking the time to respond to my post Doctor. I would be very grateful if you could shed some light on my other questions.

My last ultrasound from this week states:
History: Echogenic mass right lobe of the liver demonstrated on earlier studies.

The visualized hepatic parenchyma demonstrates a well circumscribed hypoechoic mass right lobe of the liver measuring 1.9 x 1.7cm. This is without significant change in size and appearance compared with the ultrasound in February.

The gallbladder appears normal without stones. No gallbladder wall edema or pericholecystic fluid collections are present. The common bile duct measures 3 milimeters.
Right kidney appears grossly normal without hydronephrosis. No fluid collections are present in the right upper quadrunt.

The pancreas is not completely visualized but where seen appears normal.

IMPRESSION: Well-circumscribed hyperechoic mass measuring 1.9x 1.7 cm right lobe of the liver without significant change compared with the ultrasound from February. This likely represents an incidental hemangioma. A follow-up study in 6 months time recommended
.------------------end report
Is says hypoechoic above but in the IMPRESSION part of the report it then says hyperechoic? Which one is correct? In the past it was always hyperechoic. Also it seems it has grown at last ultrasound I was told it was 18mm but now the new ultrasound says its 1.9 x 1.7 cm. Is this just because there's a margin of error with ultrasound measurements? Or has the hemangioma grown? Am I correct in thinking it has grown but not significantly?

Is a MRI still a good idea? And if I seek a second opinion if so what type of Doctor do I seek a second opinion from?
Thank You
Avatar universal
Forgot to mention above that my last blood test came back high as Bilirubin Total 1.6 (range:0.2-1.0)

Direct Bilirubin 0.3 (range:0.0-0.3)

Is this related or something to be concerned about? I've never had high values with bilirubin in the past. I was fasting for this blood test for about 14 hours.
517301 tn?1229801385
MEDICAL PROFESSIONAL
the hemangioma is hyperechoic and from the measurements it seems that it is actually the same size---18mm=1.8cm.  i wouldn't worry about the size.  get the MRI for peace of mind.  i would seek the opinion of a hepatologist if you need a 2nd opinion.  the elevated bilirubin while fasting is most likely Gilbert"s disease, a benign enzyme defect of the liver.
Avatar universal
Thank you so much for answering my post Doctor I truly appreciate it. I'm a bit concerned and confused because I was first told that on CT scan it was 1.8 cm which equals 18mm in maximal dimension and I was given no other dimension on the CT scan. The first ultrasound that I had in February stated that it was approximately 1.8cm which equals 18mm, so no change there. But now this most recent ultrasound says 1.9 x 1.7 cm. Am I missing something? I thought 1.9 cm=19 mm? Does this mean it grew or does it mean it's a better measurement now? Can you tell me what maximal dimension means?

Thank You
517301 tn?1229801385
MEDICAL PROFESSIONAL
i think in essence this is the same size and would not worry about a change of 1 mm
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