HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Abdominal Pain After A Trip. Took De-worming And PIP Medication. Ultrasound Came Normal. What Is The Reason?

Posted on Wed, 27 Nov 2013

Question: Hi, 37yrs mail, non smoker, social drinker, asian indian. I travelled to india 6 months back. 2 months in to the trip i developed mild lower left abdomen pain. Ultrasound shows normal. Doc gave dewarming, PIP medications along with a 5day Antibiotics. Pain had not subsided completely but not got worse. Went to doc a month after same treatment with extended PIP medications. Felt better initially but later same problem. Overall problem remains same. Very low left abdomen discomfort. Returned to USA, saw a doc. Since the symptoms are minor thought acid reflex, asked me continue PIP. 3 months in to the issue, no improvement and not getting. Though i was not feeling hungry i could eat normal, stool color is darker than before.no weight loss, infact gained 2-3 pounds. But i started noticing acute liver/chest burning after alchohal/spicy food. Went to doc, recommended upper endoscopy. Results normal, but had i fever on the day so went to ER. CT scan performed, shows pneumonia and 1.8cm,43hu solid well circled cyst on left liver lobe.ER doc asked me to followup with physician for further scanning/followup. He don't think it's simple cyst because of hyper-density. I have no history of liver problems, or cancer. Very healthy person. But i have D vitamin deficiency and on prescribed medication. With this background, any of you probably think what's going on? I have appointments next week. But want to check with you. Thanks

Answered by Dr. Dr. Klerida Shehu (1 hour later)

Brief Answer: Please refer to the following suggestions.... Detailed Answer: Hi, According to the Ct-scan description, there are many diseases which resemble to yours, however, further tests are needed. The most probable causes that goes to your clinic are: - hemangioma - focal fatty liver (due to social alcohol consumption) - abscess (maybe due to typhoid acquired in India) or - liver adenoma All of these diseases are what we call benign (not seriously affecting your health). You can discuss them with your GI specialist too and he will know the relevant test that are needed. In the interim I'd also suggest to monitor your temperature, record the results and pass them to your doctor for further evaluation of pneumonia. Hope this answered your questions! If you have more concerns, please write back to me! dr. Klerida

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Klerida Shehu (1 hour later)

Thanks Doct. Temparature seems well between. 97-98.5 most of the time. The ER report also mentioned elivated WBC i think around 0000. i am also sending the ER report here. Let me know if u have additional thoughts. Is there anything specific that u want me to bring up with my Doctor when i see him on Monday? I also have chest tightning/throat tightning while eating food? Any reason/ remidy? ER report below. ----------- CT ABDOMEN AND PELVIS WITH CONTRAST October 29, 2013 11:41 PM HISTORY: Abdominal pain and fever. TECHNIQUE: Images from diaphragm to pubic symphysis with oral contrast and 69 mL IV Isovue-370. COMPARISON: None. FINDINGS: Abdomen and Pelvis: Mild lingular infiltrate. The right lung base is clear. 1.8 cm round well circumscribed hypodense lesion along the anterior left lobe of the liver. This measures 43 Hounsfield units and does not appear to be a simple cyst. This is indeterminate and was not noted on the initial preliminary report. This could be a complex cyst, cannot exclude a homogeneous hypodense solid lesion. I discussed this finding with Dr. XXXXXXX XXXXXXX in the Southdale Emergency Room on 10/30/2013 at 8:20 AM as it was not noted on the initial preliminary report. This could be clarified with liver MRI. Normal-appearing gallbladder, spleen, pancreas, and adrenal glands. There is very mild bilateral hydronephrosis likely due to the very distended urinary bladder. The bladder is 12 cm in craniocaudal dimension with the dome of the bladder just inferior to the umbilicus. No periaortic or pelvic adenopathy or free fluid. No acute appearing bowel abnormality. Right L5 pars defect compatible with spondylolyses. Impression IMPRESSION: 1. Mild lingular infiltrate would be compatible with a lingular pneumonia. 2. Indeterminate 1.8 cm hypodense lesion left lobe of the liver. Could be a complex cyst or solid lesion. Well circumscribed margins but hyperdense for a simple cyst. Liver MRI may be helpful for clarification or comparison with any outside films for stability. Alternatively could consider ultrasound for further evaluation/followup. 3. Distended urinary bladder. Mild bilateral hydronephrosis is likely secondary to bladder distention. -------

Answered by Dr. Dr. Klerida Shehu (31 minutes later)

Brief Answer: Please refer to the following suggestions... Detailed Answer: Hi, Thank you for writing back. I have read your ER and Ct-scan reports carefully, and they refer to an infectious disease. It is good that your temperature is normal, meaning that the antibiotics you are taking are doing their work well. - With regards to the liver lesion, it goes for an infectious disease such as echinococcosis, typhoid or other abscess. It is good that you are set to have the MRI, however, I'd suggest to ask your doctor to investigate for these 2 infectious diseases too. - With regards to chest tightening while eating, it is related to pneumonia. Another factor could be candida infection of esophagus caused by antibiotics. So, you can ask your GI specialist to start antimycotic drugs (I usually prescribe nystatin). - At the end, I'd recommend to consume hyper-caloric foods to get enough energy to combat infection. Hope it helped to get the right diagnosis! Wish you fast recovery! Dr.Klerida

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Klerida Shehu (18 hours later)

Thank you doctor. I'll mention that do my doctor here. The other questions i have about cyst is why is it 43 hu? Is that common for bacterial infection? And how come in india they didn't find out during ultrasound that was performed 4 months back? Is there difference between having in left lobe vs right lobe of liver? Thank you again.

Answered by Dr. Dr. Klerida Shehu (6 hours later)

Brief Answer: Your questions answered below... Detailed Answer: Hi, Thank you for writing back. - With regards to why your cyst is 43 Hu?, I'd say that each lesion types has its own measurement. Such description will help us (doctors) to find out the final diagnosis as mentioned earlier. So, the cyst in your liver is not containing neither simple water or gas; but other components too. - Perhaps it is a bacterial infection, but first should do the culture of your blood (hemo-culture we call it). - There are 2 reasons why it was not caught in India: 1. Perhaps it did not exist that time and it was formed later on. 2. The lesion was so small that the echo could not catch it. - No difference in locating in left vs right lobe exist; the difference is related to the size of the lesion independently to the location, the treatment strategy is the same. Wish you health! Dr.Klerida

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Klerida Shehu (1 hour later)

Thank you doctor. I will update you after my findinds here. I really appreciate your detailed responses. Thank you!

Answered by Dr. Dr. Klerida Shehu (16 hours later)

Brief Answer: Your're most welcome! Detailed Answer: Hi again, Glad to know my medical advice are helping to find the right diagnosis. I'm waiting for your medical updates. Wish you health. Honored to get your updates soon and assisting further. Dr.Klerida

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Klerida Shehu (29 hours later)

Dr, i got Complete Blood Count test, urine test and Ultra sound. Attaching results for cbc and urine both are normal. However, ultrasound report indicated Resolution of Kidney and bladder enlargement. And doctor asked me to get liver MRI done. Pl advice

Answered by Dr. Dr. Klerida Shehu (16 hours later)

Brief Answer: MRI suggested for further evaluation.. Detailed Answer: Hi, I'd suggest to first do MRI as it is an examination that will give more details of your current situation and would help in the differential diagnosis of the liver problems. Once you have the MRI results in, can send in to me to have a look and get second opinion. I'd be glad to assist you. Dr.Klerida

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Klerida Shehu (10 hours later)

Doctor, i got the results from ultrasound. Please find attached, waiting for the MRI results. Please review and let me know. I will upload MRI results tomorrow. Thanks

Answered by Dr. Dr. Klerida Shehu (14 hours later)

Brief Answer: Waiting for the results of MRI to be in... Detailed Answer: Hi again I have run through your abdominal ultrasound, and I have noticed the cyst you mentioned before. From the description, it might seem of infectious in nature. So, MRI would better determine it as diagnosis. With regards to the dilated ureter of the right part, there is no evidence of other kidney problems such as the stones and/or if they are congenital.Even in this case, I'd suggest to wait for the result of MRI Looking forward to have your results soon. Dr.Klerida

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Klerida Shehu (42 minutes later)

Attaching theMRI results. Can u please review doctor?

Answered by Dr. Dr. Klerida Shehu (18 minutes later)

Brief Answer: Could you please bring the entire MRI result in? Detailed Answer: Hi, Thank you for bringing the results of MRI in, Before getting to a conclusion, could you please bring a copy of the entire MRI results. The one I got included only the conclusion part. As I'd like to know about the whole test results (description), I kindly ask to get the entire MRI result. Thank you. Dr.Klerida

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Klerida Shehu (31 minutes later)

Attaching the first page of MRI

Answered by Dr. Dr. Klerida Shehu (20 hours later)

Brief Answer: MRI results,ciliated hepatic foregut cyst... Detailed Answer: Hi, again Thank you for bringing the results of MRI in. I have run the MRI results and what I could see is that all the results refer to a benign lesion (i.e. ciliated hepatic foregut cyst). This is not associate with the pneumonia you are currently being treated. I'd suggest to wait for other 3 months and repeat the MRI again. For the time being, I do not see any need to treat the cyst. Moreover, get your pneumonia treated well, have more rest, and follow the doctor's advice accordingly. Hope it answered to your inquiry! Wish fast recovery! Dr.Klerida

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar