I have actual CT report and would love some help understanding it

[Guest guest]

Last week I posted based on the phone call with the doctor's

assistant but I requested a copy of the actual report and here are

the findings and the conclusion. I would love some help

understanding what is next based on this are we looking at an ERCP to

open some bile ducts or are we looking at the other procedure with

the drain tube or something different or is there nothing that the

doctors will be able to do. Does this indicate that parts of the

liver ar starting to go bad?

Findings: The lung bases are clear. The liver demonstrates

heterogeneous areas of low-attenuation on the precontrast images

involving most of the right hapatic lobe and the medial segment of

the left hepatic lobe. The lateral segment of the left hepatic lobe

is very small. Following contrast administration, these areas of low

attenuation do not enhance significantly while there is normal

enhancement of portions of the liver predominantly seen posteriorly

in the right hepatic lobe. There is indeed mild prominence of the

intrahepatic ducts seen best in the small lateral segment of the left

hepatic lobe and posteriorly in the right hepatic lobe in hte areas

of sparing. No well-defined masses are seen in the liver. The

portal vein is patent and the hapatic vein is patent. The

gallbladder and common bile duct appear normal. A few small

perigastric and periportal lymph nodes are identified measuring up to

1 cm in diameter. The spleen is normal in size and demonstrates

homogeneous normal enhancement. The adrenal glands and kidneys

appear normal. There is no retroperitoneal lymphadenopathy.

Conclusion: Heterogeneous low-attenuation and diminished enhancement

within much of the medial segment of the left hepatic lobe, the

cadste lobe, and much of the right hepatic lobe. Areas of sparing in

hte lateral segment of the left hepatic lobe and posteriorly in the

right hepatic lobe demonstrate moderate intrahepatic ductal

dilation. It would be very unusual for geographic fatty infiltration

of the liver to result in mass effect on the intrahepatic bile ducts

resulting in ductal dilation in the non-affected segments. However,

no central obstructing masses are seen and the common bile duct and

gallbladder appear unremarkable. The significance of these findings

is unclear. Unusual etiologies such as autoimmune liver disease

could be responsible but again the appearance is nospecific. Liver

biopsy may be beneficial for further clarification.

{Note: I am not sure that the radiologist had any idea has

PSC because the Indication for the CT was: Elevated liver function

tests.}

Also, the above was from a 3/9/07 CT scan. It was compared to an

8/21/2006 CT scan which I will list the details from below. Is this

a lot of change in less than a year and is that normal for PSC?

8/21/06 Findings (I will only list the liver stuff - Note for this

one the indication said : Primary Sclerosing Cholangitis instead of

Elevated LFT): There is fatty infiltration of the liver. There is

stable appearing biliary ductal dilation within the lateral segment

of the left lobe and within the posterior segment of the right lobe.

No definite focal hepatic masses are identified. There isa stable

appearing lymph node in the hepatoduodenal ligament identified on

image #61. There ia stable appearing peripancreatic lymph node

identified on image #51.

8/21/2006 Impresssion: Stable appearing biliary ductal dilation

(intrahepatic). Stable appearing fatty infiltration of the liver.

Stable appearing hepatoduodenal ligament lymph node. Stable

appearing lymph node in the peripancreatic region.

Thanks in advance for helping me understand the significance of these

changes from 8/21/2006 and 3/9/2007.

Nichole Rowland

(wife of PSC & UC 08/2004)

[Guest guest]

The last report suggests that only two areas of the liver appear to be

functioning and looking fairly normal; the lateral part of the left

lobe and the posterior section of the right lobe. No definitive area of

ductal enlargement is seen and therefore dilation of the ducts would

probably not be of benefit. However, a contrast MRI might provide a

better picture of what is going on with the liver and the ducts. No

mass is seen and this is a good thing because it means that there is no

cancer to cause the picture of the poorly functioning areas of the

liver. On the positive side the liver doesn't appear enlarged or

shrunken and neither does the spleen. An enlarged spleen and a fibrotic

looking liver mean that portal hypertension and varices are far more

likely to be present. Since your son has been diagnosed with PSC

further imaging studies should probably be ERCPs and MRIs, because what

you want to know is what is going on with the ducts which tend to be

better seen on MRI and more obviously using ERCPs. The timing and

repetition of these studies depends on symptoms and other signs. The

other test that may be necessary down the road is an endoscopy to look

for varices. Early on none of these tests needs to be done on a regular

basis.

Aubrey, MD

PSC '81, UC '90, LTX '98, Recurrence '05

[Guest guest]

Aubrey - Thank you so much for your insights. It is really nice to

have someone who can help a lay person like myself to make sense of

these things. My husband has had elevated liver tests since 2001 but

until 2004 they just thought it was fatty liver (he had a liver

biopsy in 2002 but they said it was fatty liver). In 2004,

thought his rectal bleeding was from hemroids but when he was scoped

they said that they had taken a sample for biopsy but it looked like

colon cancer so they sent him for scans to look for cancer in other

areas. The biopsy came back inflamation instead of cancer and he had

to have a very large pseudopolyp removed (it took two colorectal

surgeons and hours to prevent removing a section of the colon since

the pseudopolyp almost went around the entire colon). During those

scans they discovered the dilation in his bile ducts and suggested

that he may have PSC. I found this board then and heard that we

should get him a hepatologist so that is what we did. He has been

having colonoscopies every year and had his only ERCP in 2005. His

colonoscopies in 2005 and 2006 showed that the colon growth had

recurred but they did not want to send him for surgery to remove it

again. His ERCP in 2005 confirmed the PSC diagnosis but they did not

do anything other than look at things during the ERCP.

In 2007, he has basically felt a lot worse he has been hurting in his

liver most (but not all) days and he has been tired and itchy and had

a lot of swelling in his ancles. His CA19-9 have been rising but

they are still well below 100 but they are no longer in the normal

range. His biluribin has also been increasing but it is not quite

abnormal it is at the high end of normal now whereas it use to be at

the low end. So basically, he has most likely had PSC since at least

2001 although he was not diagnosed until 2004 and it seems like he

has been mostly feeling good all those years he is now having a more

difficult time with things. He has also had regular MRI's or CT's

since 2004 that until this last one basically said things seemed

pretty stable (they were actually doing those to track some nodules

in his lungs that were discovered when they thought he had colon

cancer). So when I read this report where the word 'stable' was not

even mentioned and I consider how much worse he feels. I wonder how

bad is this. Are they going to be able to do anything to make him

feel better or is this the beginning of the walk to a transplant. I

mean this scan was only 6 1/2 months since the last one where

everything was stable. Is he going to keep progressing this fast now

that he has started getting worse. Is it normal for someone with PSC

to be stable for a long time and then get so much worse so fast?

I am sorry to be so long winded. You know it is impossible to

express all of this in a doctor's office.

Kind Regards,

Nichole (wife of PSC & UC 08/2004)