Dr. Chitrangada Jitendra
Radiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I need a detailed magnetic resonance imaging (MRI) review and report for my problem. Is that possible? Thank you.
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. Thank you.
Patient's Query
Hello doctor,
Thank you for your response. 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 ultrasonography (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 magnetic resonance imaging (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. Thank you.
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. Thank you.
Patient's Query
Hello doctor,
I have attached all my reports and history. Computed tomography (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, Ultrasonography (USG) revealed edema and my symptoms were back (low fever, swelling, and tiredness) and antitubercular therapy (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 C reactive protein (CRP) and mild serum angiotensin converting enzyme (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 magnetic resonance imaging (MRI) images?
Thank you.
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. Thank you.
Patient's Query
Hello 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 persistent 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. Thank you.
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. Thank you.
Patient's Query
Hello doctor,
Thank you for the reply. I consulted a rheumatologist and orthopedic doctor and have attached both prescriptions. They suggested tablets Saaz-DS and Nucoxia D3, which I have been taking for the last 15 days and felt relief too, but now he has suggested tablet Lorsaid P 8 and Baclofen 10 mg. I read a lot of its side effects. As per my reports, please suggest whose prescription should be followed for better recovery and outcome for sacroiliitis and associated problems? Is this possible, as all these three years there was muscle inflammation. I am attaching the first MRI, which stated some irregular streaking of fat in the surgical incision, and the latest MRI, which says some chronic right groin strain; what does that mean? Is it some injury that created a sinus tract? It was thought to be TB, though there was never any discharge. Kindly help.
Hi,
Welcome back to icliniq.com. I understand your concern. The streak artifacts in the earlier scans were due to air foci within the infected sinus you had at that time. I would suggest that you consult a rheumatologist rather than an orthopedic surgeon, as they would be able to manage the whole spectrum rather than just the sacroiliitis. As discussed earlier, the tablet Saaz-DS (Sulphasalazine), which acts as all the mediators of inflammation in the body, will work for all your symptoms at once rather than taking separate tablets for each. The benefits outweigh the side effects in your case; however, regular consultation is suggested. Kindly report if you get drowsiness, nausea, or dizziness, but I feel this treatment regimen would drastically target and relieve you of the pain and discomfort for good. Muscle strain usually does not form sinus, so do not think on those lines unnecessarily. Let me just go through the scan (attachment removed to protect the patient’s identity) thatyou have uploaded, and I will get back to you. Kindly revert in case of further queries.
Patient's Query
Hi doctor,
Thank you for the reply. I have a history of allergic bronchitis and asthma. Will taking tablet Saaz-Ds be safe? I have read online that this tablet increases the risk of reactivation of tuberculosis (TB) and has already been affected twice in three years. Will proceeding on this tablet be safe? Also, the area mentioned in my latest magnetic resonance imaging (MRI) of groin strain still gives me pain at all times, and it is the same area where the sinus originated. Can you please explain what could be this? And how can this be resolved? Kindly help.
Hi,
Welcome back to icilniq.com. I understand your concern. I think the doctors reporting the MRI (magnetic resonance imaging) did not have a complete history. The abnormal area in the groin where u had sinus has been mentioned as strain due to altered signal on MRI (attachment removed to protect the patient’s identity). I feel you should not worry about the reactivation of tuberculosis, as it is just a little possibility and not definite. I hope you understand. Thank you.
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