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Q. Please explain the MRI report for abdominal discomfort.

Answered by
Dr. Chitrangada
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 20, 2018

Hi doctor,

I need a detailed MRI review and report for my problem. Is that possible?

#

Hi,

Welcome to icliniq.com.

Sure, you can upload your scan with a proper history. Also, mention the areas of concern and re-evaluation regarding which aspect of the scan you want to know. That would ultimately benefit you.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

Thank you doctor,

I had a C-section delivery four years back. Postoperatively I was having abdominal discomfort which started from my stitch line on the right side. Three years back, a USG reported an avascular sinus tract in right anterior abdominal wall from preperitoneal space up to skin for which treatment was given for one year, but still, problem gradually developed in the left side also. Various USG and MRI conducted in all these years showed adhesions, panniculitis, and inflammation in subcutaneous fat.

I have got an MRI done now for which I need a review. Please guide me where is the actual problem and how can this be managed. Kindly provide me with a detailed reporting having smallest details, so that if any surgical intervention is required can be taken care of and we can get some right direction.

#

Hi,

Welcome back to icliniq.com.

Looking at the clinical papers and scans (attachment removed to protect patient identity), your physician is considering inflammatory pathology likely auto-immune mediated. The adhesions are postoperative changes and are bound to happen after any surgery. Focal panniculitis is definitely seen but I would want to know if that has been persistent. Was any CT (computed tomography) scan of abdomen done for you? And if possible, do attach previous scan reports also which you have done over time because if the region of panniculitis is the same, getting scans repeated does not sort the problem but investigating its cause would be worthwhile. I would also recommend that do not rush with biopsy.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician


Thank you doctor,

I have attached all my reports and history. CT scan was not done for last two years, so I do not have reports. It was done two years back but after eight months of my surgery, the track was healed and it only showed some adhesion in sigmoid colon and ovary but again after finishing treatment a year back, USG revealed edema and my symptoms were back (low fever, swelling, and tiredness) and ATT was started again. But, when a second opinion was taken a year back, that USG reported it to be panniculitis, which is again showing in usg three months later (same findings).

Kindly tell me based on the recent reports where do I stand and what should I do? Which doctor should I consult for this? Is this cancer which has been misdiagnosed all these years? Can this be because of cellulitis? I am sick of taking antibiotics, or some suture granuloma or abdominal wall endometriosis. What kind of focal deposition could this be? My rheumatologist has conducted all the basic tests, but they are negative except CRP and mild serum ACE levels elevated. Is this hernia? Is there any problem with my kidneys also? Is biopsy not safe for this? Is focal panniculitis visible on MRI images?

#

Hi,

Welcome back to icliniq.com.

The summarized interpretation (attachment removed to protect patient identity) likely suggest immune-mediated panniculitis with associated iritis and sacroiliitis. Raised ACE (angiotensin-converting enzyme) levels and CRP (C-reactive protein) also support this.

Recurrence of Koch's infection is less likely. The possibility of cancer or neoplastic etiology is highly unlikely. Consulting a rheumatologist would be best for follow up. You need to take immune modulators rather than antibiotics which your rheumatologist would suggest. Chances of cellulitis are unlikely. No hernia is there in the present scan. Mild focal panniculitis is persistent.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician

Thank you doctor,

Is that persistent focal panniculitis is on the left side near umbilicus area? I feel a strong lump in the area. Is that possible it is because of any infectious pathology? If it is peristent for a long time, can a biopsy be done as suggested by my surgeon to rule out and plan treatment accordingly? Is fat necrosis still persisting in subcutaneous fat?

I have a history of allergic asthma and my serum IgE levels are always above 800 almost. Can this be a contributing factor? Does that scan show hydronephrosis or some kidney stone too? And what about divarication of rectus abdominal muscles? Please check for psoas sheath thickening also.

#

Hi,

Welcome back to icliniq.com.

There is persistent focal panniculitis on the left side near umbilicus area. The possibility of infectious etiology is highly unlikely looking at your previous reports (attachment removed to protect patient identity).

A biopsy can be done as suggested by your surgeon. The fat necrosis in subcutaneous fat is not seen at present. History of allergic asthma and serum IgE levels are all pointing towards autoimmune etiology, again against the favor of infections. Divarication of rectus abdominal muscles is not that significant and is quite commonly seen in females post childbirth. No significant psoas sheath thickening is present.

For more information consult a radiodiagnosis physician online --> https://www.icliniq.com/ask-a-doctor-online/radiodiagnosis-physician


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