Radiology/U/S & CT interpretation
QUESTION: My husband is a 63 y/o Vietnam Veteran helicopter pilot disabled with PTSD. Life-long nicotine addiction as well excessive alcohol altho he went approx 5 years without then began to drink moderately again a few years ago. He has Reynauds in his hands and COPD prob stage 3 but otherwise remarkably healthy altho he does seem more fatigued and resting/sleeping from something other than COPD. For approx a year he has been experiencing what appears to be a 'cramp' slightly below left rib cage area. It is pain that stops him in his tracks, he grabs his left side, bends forward and walks gingerly to a place to sit. There is a visible 'hump' in the area. After bringing this to his VA PCP (VA is his primary healthcare) attention she took the following action:
On Jan 17, 2013 he had an ultrasound of his liver and spleen. The following is the report verbatim:(it was same for both tests)
****PERTINENT FINDINGS: Pancreas incompletely visualized, limited diagnostically Live sie appears borderline for enlargement and has one measurement of 15.7 centimeters. In general liver parenchyma appears. No focal hepatic lesion revealed persisting in orthogonal planes. Gallbladder contains at least 2 mobile hyperechoic subcentimeter echodensities. There is no GB wall thickening or pericholecystic fluid. There is no sonographer comment regarding tenderness to transducer pressure, therefore correlate clinically regarding significance. CBD caliber is 5-6mm and appears normal. Spleen appears enlarged with one measurement 13.7 cm. Limited, but otherwise unremarkable appearing, views right kidney reveal length 9.8 cm. IMPRESSION: 1- enlarged apleen, 13.7-cm 2- liversize borderline for enlargement 15.7-cm 3- at least 2 subcentimeter GB calculi 4- pancreas incompletely visualized. Primary Diagnostic Code: Abnormality Follow-up needed. ****
On May 6, 2013 his PCP had a CT W & W/O CONNTRAST ABDOMEN as well as an LOCM-CT done on him. (NOTE: he was experiencing an upper respiratory infection at time of this report)
The following is that report verbatim: (it was same for both tests)
**** There is hepatosplenomegaly. A small accessory spleen is seen on axial image number 18. No nephrolithiases, hydronephrosis, AAA, free fluid or free air. There is a tiny umbilical hernia containing fat. Small calculus is suspected in the gallbladder. No acute choecystitis, pancreatitis. There are vascular calcifications. Degenerative changes are seen in the regional bones. 1/45 cm sized lucency in the left posterior ilium near the SI joint is of indeterminate nature. IMPRESSION: 1. Hepatosplenomegaly, accessory spleen. 2. Cholelithiasis. 3. Nonspecific lucency in the left posterior ilium. Clinical correlation suggested:****
That seems like a lot to ask about but I specifically can't figure out:
1)From the May 6, 2013 CT scans: Where are the 'vascular changes' they are seeing on this abdominal CT .... can they see his heart well enough on this scan?
2) What disease if any is indicated with 'degenerative changes are seen in the regional bones'.
3) Is the '1.45 lucency in the left posterior ilium' something of concern?
4) From the Jan 17, 2013 ultrasound report could you tell me if 'general liver parenchyma' is conclusive for some type of liver disease?
There were several types of blood tests done.
On an Auto Chem 8 test he had low 'UREA NITROGEN/CREATININE' at 11.2 on April 5, 2013 but it had increased to 16 on May 6, 2013 lab
Also,lab test Hemogram V shows 'LYMPHOCYTES/100 LEUKOCYTES low at 16.3 as well as PLATELETS low at 133.
We are waiting now for a follow-up appt with his VA PCP to discuss the latest CT scans.
Thank you so much for your time and expertise in helping me understand what is/or could potentially be happening.
ANSWER: Hello, Terri.
First of all, please express my gratitude to your husband for his service to our country. I truly appreciate what he sacrificed for all US citizens.
Before I begin, remember I am only a photographer. I am not qualified to diagnose disease. Your doctor is the best one to interpret these results for you. Here's what I know:
CT and Ultrasound are two entirely different imaging modalities. CT uses x-ray and Ultrasound uses sound waves. These modalities compliment each other, but are used to visualize anatomy in completely different ways. So what is seen via one modality doesn't necessarily appear in the other.
1) By "vascular changes" are you referring to "vascular calcifications"? This probably refers to plaque buildup in the patient's arteries, commonly called "hardening of the arteries". This condition can be mild or severe, depending on how much calcification there is. The heart is not visualized in either Ultrasound of the liver/spleen nor CT of the abdomen.
2) Since the CT report is of the abdomen, 'degenerative changes are seen in the regional bones' is probably referring to the spine. Degenerative changes are normal effects of aging like arthritis. I bet his back hurts.
3) The '1.45cm lucency in the left posterior ilium' is a bright spot (on the image) in the left pelvic bone near the left rear dimple just below his waist. I don't know what this could be, but more times than not, these things are normal abnormalities. Radiologists must describe everything they see. Probably nothing to worry about unless he's having a lot of pain in that area.
4)'In general liver parenchyma appears' is not conclusive for some type of liver disease. I think it just means that the functional tissue of the liver is seen.
I have no knowledge of how to interpret lab results.
Hope this helps a little.
---------- FOLLOW-UP ----------
QUESTION: Thank you Delia for appreciating our veterans, they are a 'soft-spot' for me :)
Yes, I did intend to say "vascular calcifications". If it isn't the heart arteries they are referring to then what vessels are they seeing on abdominal ct that can calcify?
As far as the "degenerative changes seen in the regional bones" he absolutely has no back pain. He never has and hopefully that is a good sign?
I am still concerned about the "liver parenchyma" since both his liver and spleen are enlarged. Time and hopefully his PCP will clear this up for me as well as the 'lucency' issue.
Thank you for your time in responding. I value your insight and the fact that you guys do this just to be helpful to the general public. Keep up the good work.
I bet the radiologist is talking about calcium in the aorta. It's very common to see calcifications in an aorta.
As I said before, radiologists report absolutely everything that they see; good or bad. It's just an observation that the patient's bones aren't as young as they used to be. That's all. Don't be concerned about this.
Yes, be sure to bring all your questions to your PCP. I usually write them down so I don't forget in the moment. It seems doctors have so little time to spend with each patient.
Best of luck to you & your husband. Thanks for your appreciation, too!