Question: Dear Doctor,
I have a question regarding liver ultrasound results. Last year, about this time, I was diagnosed with moderate to severe fatty liver. My report stated that I had a 4mm common bile duct in the findings. The final impression was moderate to severe fatty infiltration of the liver, otherwise, unremarkable right upper quadrant ultrasound. The reason for the ultrasound was mildly elevated ALT and AST. I immediately changed my whole lifestyle. Over the year, I lost 60 pounds. I am a female who is 5 feet, 5 inches tall, weigh 132 pounds and have a bmi of 22.0. Here's where the confusion comes in. I had a follow ultrasound a couple of weeks ago....a year after my original diagnosis of moderate to severe fatty liver infiltration. As the girl was doing my ultrasound (it just happened to be the same girl from last year), she was so excited as she said that my liver looked so much better and that it still was mildly fatty, but that it was definitely improving. She said that everything looked great. However, I looked at this year's test and it states in the findings that there is no intrahepatic or extrahepatic biliary ductal dilatation. Common bile duct measures 2.2 CENTIMETERS in maximal diameter. That's 22mm, while last year's stated 4mm. In the overall impression, it states fatty liver without focal liver lesion. No sonographic evidence for acute cholecystitis. I am SO confused. My doctor told me to keep on doing what I'm doing and the fat should be gone this time next year. I get that, but what I don't understand is how my common bile duct measured 4mm in March of last year and 2.2 CM (22mm) this year, and no comment of concern from my doctor or the ultrasonographer or the radiologist? Could this be a misprint? I have a call into my doctor, but she's out of the office, so I am here scared to death of what is going on. Can you shed any light onto this? By the way, my ALT and AST have been normal since July of last year. I am a 43 year old white female. Don't know if that makes any difference. I do not have any type of hepatitis and was tested for the hemochromatosis gene and don't have it....not even a carrier. I'm so scared that this 2.2 cm common bile duct could be cancer, yet no concern or follow-up was recommended in the radiologist's report. However, the wording is different from 2014's report as compared to 2015's report. Any thoughts for a very nervous girl? Any insight would be so appreciated. I don't think I'll sleep tonight without some sort of explanation.....good or bad. Thanks so much. XXXXXXX

Shouldn't this have been noted as abnormal on my ultrasound results? I would have never known if I hadn't gone back and read them myself. My doctor reviewed them and thought they were fine and the radiologist says in the report that the extrahepatic and the intrahepatic biliary ducts show know dilatation. Shouldn't that include the common bile duct? Just curious as I don't understand all of the medical terminology. Does this sound like cancer? I am terrified! Thanks so much for your quick response!GGT 11
ALP 59
XXXXXXX

Hi,

Thank you so much for your help. I tried to contact my own GP this morning, and her nurse wouldn't let me speak to her. My doctor apparently looked at the test and said that 2.2cm was normal. Looks like I will be finding another GP! Anyways, it was making me so uneasy, that I looked up the name of the radiologist who read my report. Turns out he is the head of one of the largest and best hospitals here in XXXXXXX GA. I found his email and explained what was going on and that I could not get any results from my own doctor....much less talk to her, but that I knew this number was either wrong, or that I could be really sick.

Do you know that he called me back within about 10 minutes? He was SO kind and you were right on your first guess. The transcriptionist typed in cm instead mm. So, thankfully, everything is good. My fatty level in my liver has gone from moderate to severe to moderate. If I continue to exercise and don't regain my weight and eat right, can I expect my liver to no longer be considered fatty in the next few years?

Thank you so much for your help. For a girl with Generalized Anxiety Disorder and Panic Attacks, this whole situation has been very scary, especially since my doctor said that everything was totally normal at 2.2 cm when I knew for a fact that it wasn't. It may be time to make a change in doctors. When I called to tell them of the mis-transcription, they were still ugly to me. Not very compassionate at all, and obviously not very knowledgeable about this particular issue. What else might she be incompetent in and say is normal when it's not? Definitely something to consider.

I will continue to eat right and exercise daily. I will try to keep my anxiety to a minimum and enjoy my life, even though this fatty liver condition scares me....ALOT! I definitely want to be around for my girls and live a long and happy lifetime with the love of my life whom I married 20 years ago.

So, I guess this teaches me to appreciate my life even more and to not be fearful to stand up for myself when I know that something is off....even if it to challenge a doctor. (No offence to you....my dad is actually a surgeon in another state, but we haven't had a relationship in years.) I know that most doctors are amazing....and I know that transcriptionists make mistakes and I understand that. But for a doctor not to recognize such a huge mistake when brought to her attention and her nurse was ugly to me, I feel like I am not important as an individual. They could've cared less that I was worried and instead, chose to make sarcastic comments to me about looking on the internet and that I was absolutely wrong and my doctor correct.

I pray that more doctors like yourself and the radiologist I spoke with today will demonstrate to other physicians about the true meaning of treating their patients with true compassion and dignity. That wasn't the case today with regard to my GP and her nurse. Thanks for being compassionate and kind to me. I really appreciate it, and I'm sure your patients to as well.
Oops, fatty liver has gone from moderate/severe to moderate, so it is improving.
Thank you for your help!
XXXXXXX