Dr. Ruchi Sharma
Radiodiagnosis
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
Hello doctor,
I have had three MRIs recently, but I only want the brain MRI and the pelvic MRI to be looked at. I have symptoms of multiple sclerosis, but the doctors think I have fibromyalgia because my brain is normal, and pelvic MRI suggests congestion. For the past two years, I have had pelvic pain, kidney pain, needle pin numbness, weakness, blurry vision, brain fog, frequent urination, muscle spasm, twitching all over my body, and a crawling sensation under the skin. I also experienced pain during and after sex, chronic lower pelvic pain, and lower ight side back pain along with bloating. An ovarian cyst was missed last year, along with a kidney issue which seems to be a ureter blockage constriction for which I am getting a pyelostomy done.
Hello,
Welcome to icliniq.com.
Brain MRI images of T2W/ FLAIR hyperintensities noted in bilateral periventricular deep white matter are suggestive of likely microangiopathic changes (small vessel involvement). Juxtaventicular T2/ FLAIR hyperintensities (body of bilateral lateral ventricles) suggest ventriculitis. The rest of the brain's parenchyma is normal.
Have you undergone recent low back surgery as there are inflammatory changes in the myofascial planes of the lower back (L2-S1 level)?
Take care.
Patient's Query
Hello doctor,
I did not realize the brain would be looked at as they asked which one, and I wanted the pelvis, but thank you, as you wrote, my brain was all normal and had no issues. So, could these brain things cause multiple sclerosis symptoms? And to answer your question, no, I have not had any lower back surgery. It is just a missing filshie clip from sterilization the surgeon accidentally dropped during removal in the pelvic region, but they stated no harm would be done from it. I have attached a CT scan of where it is located.
Hello,
Welcome back to icliniq.com.
In case you have any more questions, you can reach out to me.
Take care.
Patient's Query
Hello doctor,
I consulted my doctor with what you found on the brain scan and on my lower back, but they are stating everything is normal, and nothing is there on the scan. Is there any way you can say which slide series number these are where you found these hyperintensities on the brain and inflammation of the lower spine? Or even a written report on your findings?
Hello,
Welcome back to icliniq.com.
Sorry to hear about the stress that you have been going through because of different opinions regarding the imaging findings. So, I do not have access to your previous imaging files at present, owing to patient privacy policies. The best I can do is that you resend the brain file to me, and I will discuss it with my colleagues here.
Please let me know if that would help.
Take care.
Patient's Query
Hello doctor,
The files are already attached. I will not be able to post back after this, but yes, if you and your colleagues could look, that would be great. If you could let me know what series or slide these issues are on and possibly write a small report on the findings.
Hello,
Welcome back to icliniq.com.
So, I discussed your MRI (magnetic resonance imaging) findings with one of my colleagues, and he is also of the opinion that few discrete T2/FLAIR hyper-intensities seen in bilateral periventricular white matter (centrum semiovale) in your brain MRI images could be suggestive of microangiopathic changes.
The following paragraph is for general information:
Microangiopathic changes are ischaemic changes occurring in blood vessels of white matter. White matter is part of the brain parenchyma that contains nerves that serve as a connection to other parts of the brain. High blood pressure, diabetes, and increasing age are the basic risk factors for small vessel ischemia. Long-term implications may vary from patient to patient.
I personally would report these in a patient's MRI, even if I see only a few hyper-intensities, just so that one is aware of their existence even though no immediate intervention would be required. I am not sure about the reporting protocol followed by doctors in other countries.
I hope I have been able to help you to the best of my ability.
Take care.
Patient's Query
Hello doctor,
I have a new scan for you to look at. I am concerned something is being missed on these, I know I have a confirmed ureteric pelvic junction obstruction, but I am in so much pain and feel like the pressure is pushing against my floating rib and back. I also get night sweats where I am drenched in sweat. Palpitations were diagnosed with an irregular heartbeat from ECG. My heart beats too fast; this started this year. I blamed COVID-19 jabs as the cause. I also have itching palms and feet uncontrollably at night. I have to soak them to stop itching. I have really bad fatigue along with nonvisible blood in urine and leukocytes, but the laboratory says no infection is present. I read the report from the last CT and was alarmed at some findings, as they have never been reported before. Something with my appendix and the adrenal gland was mentioned. I am just panicking as all my pain presents on the right side. I have just had a blood test done to check my iron and thyroid, and all are normal. The only new symptom I have among all this is a period lasting one day, which is odd, so I had assumed I was entering menopause.
Hello,
Welcome back to icliniq.com.
So I went through the ultrasound and CT (computed tomography) images (the attachments have been removed to protect the patient's privacy) provided to me, and I have made the following observations:
1. Ultrasound shows dilated right upper ureter of the right kidney. This is the only finding on your ultrasound based on the images provided to me. Both kidneys are of normal size. The urinary bladder appears normal.
2. On CT, hyperdense focus (white thing, if you can notice ) is noted in the pelvis on the right side near the urinary bladder, which could be a calculus (stone), which can explain urinary obstruction causing dilated ureter on the right side on ultrasound. Such stones can cause severe pain in the pelvis. Sometimes appendicolith (calcified deposit in the appendix, seen in the right pelvis) can present this type of picture on CT and is usually not painful, but if severe pain is there in the right pelvis, then it is commonly associated with appendicitis (inflammation of the appendix) that can be seen on ultrasound and CT.
In your CT or ultrasound, appendix inflammation is not seen in the images provided. This calcified focus should have been seen on ultrasound too, but it is not seen in the images provided to me, so I am not sure about the quality of your ultrasound scan.
Has a Radiologist reported this ultrasound and CT? What is their opinion?
As for the night sweats and other symptoms, these are commonly seen in premenopausal or menopausal women, but your age is only 34 years, as I can see in the query, so ideally, you should not be perimenopausal or menopausal yet. Have you checked your thyroid levels? Such symptoms can be caused by abnormal thyroid levels too.
Let me know if there is anything else.
Patient's Query
Hello doctor,
Thank you for taking the time to look at my ultrasound report. CT reports are attached with their findings. I have recently had my thyroid checked, as my physician said, but all levels came back normal in the blood reports. I thought I was in perimenopause too. I have attached the reports for you. I am also mentioning the findings below.
1. Ultrasound technique: Transabdominal scan done with patient consent.
Findings: Kidneys are normal in size and parenchyma echo pattern, and the pelvicalyceal system is not dilated. No renal calculi were seen. The right kidney measures 10.8 cm in bipolar length, and the left kidney measures 10.4 cm. The urinary bladder is distended with clear content and normal wall thickness. Pre-micturition volume is 261 cc, post micturition the bladder is empty. Abdominal aorta is normal in calibre.
2. CT scan findings: Left pelvic surgical clip compatible with tubal ligation. No right-sided clip as before. No hydronephrosis or renal tract calculus. Chronic focal calcification was noted in the right adrenal gland, likely from a historic hemorrhage. No other significant visceral findings. No obvious intestinal pathology in this non-contrast, unprepared study. Subcaecal appendix containing hyperdense material as before. Clean periappendiceal fat planes. Reactive appearing mesenteric, retroperitoneal lymph nodes. No significant adenopathy by size criteria. No fracture or sinister bone lesion. Left osteitis condensans ilii evident.
Hello,
Welcome back to icliniq.com.
Kidneys and urinary bladder are fine. The reason for pelvic pain could be pelvic congestion, as you mentioned earlier. A gynecologist should look into that. And since you are in so much pain, this definitely needs attention and treatment.
I hope you are able to get medical attention soon.
Let me know if there is anything else.
Take care.
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Radiodiagnosis
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