How to identify if a CT scan report is normal?

Hi doctor,

I had my first CT(computed tomography ) scan of the abdomen region due to elevated hormones (normetanephrine). That scan revealed a small formation of 6x7 mm in the left adrenal gland, suspicious for an adrenal adenoma or pheochromocytoma according to normetanephrine elevation. I showed the results of this scan to a doctor. After taking a look, he suggested performing the whole body CT screening and a brain MRI because he suspected this formation could be a metastasis from another tumor. It is worth mentioning that at the same time, I experienced night sweats and weight loss.

I did what was suggested, and the new CT scan revealed several new findings, in particular, two cysts in each kidney (I was aware of them due to previous ultrasounds), a small cyst in the liver, some nodules in the lungs, including one with cavitation. As for the formation in the left adrenal gland, the radiologist suggested that it was not a formation, but a lymph node, like nothing at all, was found in the adrenal gland itself.

Despite the potentially good news about the adrenal gland, I am very concerned about the number of all these findings. The general practitioners tell me that it is probably a typical situation for my age, considering the precision of the CT examination. I havee heard the same opinion from two different oncologists I asked to examine my scans. However, I am still concerned and do not feel that this is normal to have so many findings during the CT scan, also because I have done a lot of research on different clinical cases on the internet, and I did not meet people who had so many findings on CT. Apart from that, I learned about von Hippel Lindau syndrome, which manifests in multiple tumors in different organs, including adrenal glands and kidneys. So now I am afraid that it may be my case.

Returning to the CT scans, there are a few points that are of the most significant interest to me:

1. Does my left adrenal gland contain anything suspicious? Again, it looks disproportionally more significant than the right one.

2. The sinus cyst of the left kidney. Do you think the sinus cyst in the left kidney is becoming huge? I also noticed a hyperdense area on the right side. It may be a carcinoma, not a cyst, considering my general symptoms earlier this year and the potential manifestation of VHL syndrome.

3. Can these nodules in the lungs be metastasis, either from pheochromocytoma or RCC? The radiology mentioned that some of them had areas of calcification.

Thanks!

Hi doctor,

Thank you for the reply.

I want to make a few clarifications and also answer your questions.

"Regarding the size, length of the adrenal limb > 5 cm, thickness > 10mm is considered hyperplasia ( enlargement) of the gland."

Do I understand correctly that my left adrenal gland is enlarged?

"Did you get a Brain MRI? What was the result?"

Yes, I did. There were also a few findings. First, sporadic spot foci (periventricular) were found and interpreted by the MRI radiologist as an initial manifestation of cerebral microangiopathy. Also, a moderate dilation of the subarachnoid spaces was found. I consulted a few neurologists here, and they both think it's not a big deal, even though I have a few neurology symptoms like sporadic dizziness, body twitching after waking up, etc.

"Also, what are the thoughts of your oncologist or GP regarding raised normetanephrine levels?"

I've just returned from a consultation at the national institute of endocrinology. They reviewed my documents and did an Ultrasound at their place and couldn't locate any tumor. As for the elevated normetanephrine level, they think that it is clinically insignificant and might be caused by different reasons, including laboratory issues. It turned out that the special preconditions for collecting blood during that particular test that I did were not met. So, they suggest redoing the test in another laboratory, ensuring all preconditions are met.

"Note: It is normal to have multiple findings in a single CT scan, and not all those findings need to be related to one another."

This large cyst in the left kidney is becoming a significant point of my concern now. First of all, it's been growing quite fast, in two years after its initial finding it has grown more than twice in size. Also, taking into account my general conditions (night sweats, weight loss, dizziness), which are worsening since midsummer, and bad blood and urine test (protein in the urine, elevated neutrophils (67%, 4,96) and low lymphocytes (22%, 1,67)), I'm afraid that it may be not a cyst, but cancer which has metastasized to many organs, and that all that CT and MRI findings are in fact metastases. How likely is that, in your opinion?

Thanks,

Hi doctor,

Thank you for the reply.

Thank you for your previous answer, and sorry for bothering you again. But I was reviewing the images from my latest C.T. scan and decided to double-check with you on my lungs. The point is that on my last C.T. scan (three weeks ago), a new cavitational nodule was found in my left lung, which wasn`t present on two previous scans. So the radiologist suggested monitoring this nodule for now and redoing the C.T. scan in three months. However, when I looked at the scans, I realized this nodule seemed scary. And the question which bothers me a lot now is what is the origin of this nodule, taking into account that I didn`t have any infection symptoms between the previous and the latest scan.

Could you please, take a look and advise whether monitoring this nodule is a good strategy, or maybe I should insist on a biopsy?

P.S. It is also worth mentioning that during my first scan in May there also a tiny cavitation nodule was found in the left lung, but it disappeared later (I added the screen of that nodule as well - File #1)

Thanks,

Andrew