Q. I would like help understanding my ultrasound reports.

Answered by
Dr. Chandra Prakash Tanwar
and medically reviewed by iCliniq medical review team.
Published on Aug 20, 2017 and last reviewed on: Nov 09, 2019

Hello doctor,

I had an ultrasound of my abdomen yesterday and got the results today. My ALP is 155 and AST and ALT is within the normal range. I am not taking any medication at the moment, but I would like help with understanding what this means 'liver parenchyma has increased and coarse acoustic texture and correlation with liver function studies are advised. There is no intrahepatic biliary ductal dilation. No discrete masses are demonstrated sonographically'.

Dr. Chandra Prakash Tanwar

General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

  • As your abdomen ultrasound report (attachment removed to protect patient identity) shows an increased and coarse echotexture with no IHBD (intrahepatic bile duct) dilatation, the main cause is a fatty liver disease which shows an increased echogenicity in the liver. This just means you have an excess of fat deposition in your liver. But a coarse echotexture is a feature of cirrhosis of the liver (fibrosis of liver). So, for now with the limited history available, the probable cause for this could be:
  1. Chronic alcohol intake.
  2. Obesity.
  3. Chronic viral hepatitis B or C.
  • In addition to LFT (liver function tests), the following tests are required:
  1. HBsAg (surface antigen of hepatitis B virus).
  2. Anti HCV (hepatitis C virus) antibodies.
  3. Serum lipid profile.
  4. Blood sugar.
  5. CBC (complete blood count).
  6. Fibroscan of the liver.
  • Management:
  1. Reduce your weight, if you are obese.
  2. Quit alcohol, if you take it.
  3. There are certain medications which we can use according to the cause mentioned above.

Your liver function has normal SGOT (serum glutamic oxaloacetic transaminase) and SGPT (serum glutamic pyruvic transaminase), and slightly elevated ALP (alkaline phosphatase level), which has not much significance. I am more interested in the serum albumin level, serum globulin level, and serum GGT (gamma-glutamyl transferase) level.

Revert with more information to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

I am a former cancer patient. It was testicular, but a tumor developed in my left adrenal gland as well. It is 3 cm now, and my tumor markers are normal. I was first diagnosed two years ago and went through four cycles of BEP. The last chemo session was one year and five months ago. The tumor went from 7 cm to 5 cm. I had surgery last year to remove a sample of my tumor to check if it was cancerous or not. It was not cancerous. After the surgery, the tumor was reduced to 3 cm. So, there is no cancer but, I am kept in check. I hear that my tumor can elevate my ALP, but I do not know if that is the case. I was a heavy drinker at one point, but after that, I quit. My PET and CT scan from the brain to my genital area did not show any abnormalities. My liver and spleen were of normal size, but the ultrasound showed an enlarged spleen of 13.9 cm and the right lobe of my liver was 15.4.

I also forgot to mention that the quoted information I gave in my first post had 'acute findings' right before it. I do not know what that means in medical terms. Non-acute findings in the abdominal ultrasound were 'the pancreas, and the proximal abdominal aorta are obscured by bowel gas.' Again, I do not know what that means in medical terms. My basic blood work is fine except the ALP which is 155. I have a different blood work coming up on soon, to find out where the elevated ALP is coming from, but I will tell my primary care doctor about these tests that were mentioned. I know that blood work is pending. But, based on all the information that I provided, do you think this can be fixed? I am taking into consideration that the answer may not be 100 % because of the pending blood work. But, can this be fixed based on the current information? What is my prognosis based on the current information? I am eating better foods that help to heal.

Dr. Chandra Prakash Tanwar

General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

From your reply, you had testicular cancer and you were treated successfully.

  • I would like to know the time period between your last MRI scan and this recent ultrasound.
  • So, considering this new piece of information, as you have undergone chemotherapy, it might be a sort of reactivation of the hepatitis B virus or it could be something else entirely.  It can be confirmed only after a proper examination and the investigations mentioned above are carried out.
  • As you are saying that those were acute changes, I want to tell you that a coarse echotexture is a chronic condition. And, 'the pancreas is obscured by gas' means it was not properly visible during your ultrasound. Further splenomegaly again favors a chronic liver disease (coarse echotexture). I suggest you consult a gastroenterologist.
  • You eating a healthy diet is a good thing.
  • In terms of prognosis, it depends upon the confirmation of the diagnosis and its causative factors.
  • But, for now, I can say that it seems like a cirrhosis of the liver but, further investigations are needed. So, I can comment further after the other reports are available.

Wish you a great health and I am always there to help with your queries.

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

Thank you doctor,

It was not an MRI. It was a PET-CT scan which was done at the end of last month while the ultrasound was done in the beginning of this month. I will consult a GI physician as per your advice. It is my understanding that the cirrhosis of liver has different stages. I understand that it is hard to give a sure answer because of the lack of tests, but If you can elaborate more on that, it would be great. I am wondering what stages of the liver cirrhosis can or cannot be fixed. I have looked online but, there is no solid information. From what I understood, the later stages have serious symptoms like jaundice, but I have not had those yet. It has not come to the point where I need to be hospitalized which I have read is done when in likely need of liver transplant. So, I would like to think that there is hope, but I am aware that symptoms may not always be present.

Now, I do not know what stage of cirrhosis I am at yet, if at all because more testing needs to be done. But, I would like to know what stages can still be treated and still live a long time. In other words, what stage of cirrhosis of the liver would I need to be at to be considered hopeless, and therefore the inevitability of death? Another thing I would like to know is what tests need to be performed in order to detect a scar tissue of the liver. My scans did not seem to pick up any scar tissue. So, I would like to think that there is still hope, but I do not know how the scar tissue of the liver is detected. All the information that I have researched online implies that it is through imaging tests, but there are no details. So, perhaps I would like to know how scar tissue is detected through your knowledge. Please answer every little detail I have pointed out. That would be of great help.

Dr. Chandra Prakash Tanwar

General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

Thanks for the information you have provided.

  • Let me make one thing clear. Cirrhosis was just a probable diagnosis because the ultrasound was showing a coarse echotexture and there was a presence of splenomegaly. Those two points are usually in favor of cirrhosis.
  • But now, as you mentioned that there was only a few days difference between your PET-CT scan and the ultrasound and that previously your liver and spleen were normal, it seems that cirrhosis is unlikely a diagnosis because it takes years for cirrhosis to develop.
  • Yes, there are different stages, starting with fatty liver to NASH (nonalcoholic steatohepatitis) to cirrhosis which is further divided into compensated and decompensated cirrhosis. Many of the patients remain asymptomatic till decompensated cirrhosis develops.
  • Now, for the diagnosis of cirrhosis, liver biopsy is the definitive test, but there are other non-invasive tests also available. One of them is Fibroscan which is a non-invasive test which measures the stiffness of the liver.
  • It is unlikely for cirrhosis and splenomegaly to develop within 10 to 15 days of a normal CT scan. I suggest you either consult a gastrointestinal specialist or repeat the ultrasound.

I hope I answered your queries.

For more information consult an internal medicine physician online --> https://icliniq.com./ask-a-doctor-online/internal-medicine-physician

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