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Old 07-24-2010, 02:40 AM   #1
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BoxerIsis HB User
Focal soft tissue nodule *update post #8*

I know this is a very long post but I am hoping for help and I want to make sure I get everything important down.

I am 38yo 5'7 and weigh 197pds

I found out yesterday through u/s that I have a Focal soft tissue nodule on the right lobe measuring 1.5cm I didnt ask the Dr. What it could be and now wish I had since I woke at 2AM and proceeded to have a panic attack that hasnt fully left me yet

The report I got:
Quote:
The pancreas is somewhat echogenic. It is not seen in its entirety. The liver is echogenic. The common duct is 3.3 mm. The gallbladder has been removed. The visualized portion of the right kidney is normal. There is a rocal area of decreased echogenicity in the right lobe of the liver measuring 1.5 cm that is not appear to be cystic.

IMPRESSION: Previous cholecystectomy. Possibly fatty infiltration of the pancreas and liver; focal soft tissue nodule in the right lobe of the liver, measuring 1.5cm that is indeterminate. CT correlation and possibly biopsy depending on the CT is suggested for further evaluation.
I have been googling and havnt found much that is easy to understand. I of course am terrified it is cancer but it appears that cancer is not that common or at least not something to think of right away?

It all started back in Dec. last year when I had bw done because of my high blood pressure to check my cholesterol and triglycerides. The bw showed that 2 of my liver enzymes where off but the Dr. felt that my risk for not taking cholesterol med, vitoryn, was less than not treating my very high chol. and tri. levels. I reluctantly agreed to take the med knowing that no one in my family have ever been able to take a statin. By week 3 on it my muscles where so sore I couldnt even load the dishwasher so stopped the med and went back in for bw.

It showed that my muscles where being damaged as well as my liver enzymes where elevated even more.

Here are the liver enzyme readings that I have gotten over the last 8 months:
12/07/09 before starting the Vytorin
AST (SGOT) 49 Normal level (4-34)
ALT (SGPT) 70 Normal level (0-55)

1/21/10 After having been on the Vytorin for just shy of a month
AST (SGOT) 53
ALT (SGPT) 85
Creatine Kinase 146

1/26/10
AST (SGOT) 47
ALT (SGPT) 84
Creatine Kinase 153

2/08/10
AST (SGOT) 38
ALT (SGPT) 58
Creatine Kinase 253

2/10/10 (Dr. decided to add some more tests here)
AST (SGOT) 47
ALT (SGPT) 65
Creatine Kinase 229
Aldolase 9.1

4/15/10 (Results from the Rhumatologist bw)
AST (SGOT) 61
ALT (SGPT) 85
Creatine Kinase 250
Aldolase 9.8

7/8/10 (last set of bw)
AST (SGOT) 70
ALT (SGPT) 90
Creatine Kinase 178

I had my thyroid removed back in 96 due to cancer and have been fine since then. So I do have a cancer history

If anyone has any thoughts or could tell me what to search for that would be great because I am not having much luck.

I dont know when my CT scan will be the Dr. office has to schedule it and they are so slow about things like that. In the mean time I get to worry myself sick.

Last edited by BoxerIsis; 08-04-2010 at 07:24 PM.

 
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Old 07-24-2010, 06:18 AM   #2
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Re: Focal soft tissue nodule

Visit the FNH adenoma haemangioma thread as there's lots of information on there about different diagnoses etc- majority are benign. With your previous history I'm sure they are being extra cautious but remember there are lots of other growths/nodules that are completely innocent. Hope you get information soon
Mc

 
Old 07-24-2010, 01:40 PM   #3
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BoxerIsis HB User
Re: Focal soft tissue nodule

I read over a bunch last night and it did give me hope that it is something other than my darkest fear.

Do my liver enzyme levels mean anything like being attached more to one than the other?

 
Old 07-25-2010, 01:34 AM   #4
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Re: Focal soft tissue nodule

I don't think raised liver enzyme levels point to anything in particular,You may have fatty liver or something like that which would give raised levels, but an alpha feto protein test can- have you had one done? most people with these growths should have afp done as that can be an indicator for something less favourable and if raised would warrant further investigation. I believe they check mine once a year and it has stayed normal.
Sorry can't be more helpful
Mc

 
Old 07-25-2010, 12:43 PM   #5
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Re: Focal soft tissue nodule

That is helpful. I read about the AFP blood test and will request one. I am of course scared to have it done for fear of what it might show.

When I have the CT scan will it be able to show for sure what is going on or will I end up having to have an MRI or it one of those things that is different for everyone?

My Dr. didnt mention the AFP either but then she isnt a liver specialist and may not have known about the test.

I am prone to panic attacks any way when under stress and this is about to do me in. I cant concentrate on anything and I am beyond terrified. Not having any hope if it is bad is the worst thing I have 2 kids 9 and 5 and I want desparately to watch them grow up.

Last edited by BoxerIsis; 07-25-2010 at 03:13 PM.

 
Old 07-25-2010, 08:02 PM   #6
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Re: Focal soft tissue nodule

Another question if you get one FNH are the odds higher you will develop more?

Back when I had my gallbladder removed they didnt see the nodule then do they even look at the liver when doing a gallbladder u/s though?

Could me having my gallbladder removed made me more apt to get FNH because of the change in digestion?

 
Old 08-02-2010, 08:30 PM   #7
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Re: Focal soft tissue nodule

Tomorrow is my CT scan I wont know anything about it though for at least 2 days probably 3. Thank goodness for the Valium or I would be unable to function.

 
Old 08-04-2010, 02:48 PM   #8
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Re: Focal soft tissue nodule

I wanted to update for anyone who might be reading this or read it in the future. My CT scan showed nothing abnormal. So all my worry was thankfully for nothing and I can move on with my life.

Here is the report just in case someone wants to read it.
Quote:
FINDINGS: The scout view sows a normal gas pattern.

There are surgical clips in the right upper quadrant. There is minimal scarring or atelectasis at the lung bases. The right upper quadrant surgical clips in the gallbladder fossa. There are no fluid collection or inflammatory changes seen in the abdomen. No hdrocephrosis is present. On the initial images, the patient has a subltle ring-enhancing area in the inferior margin of the right lobe of the liver, but this could be artifact. No abnormalities are seen on delayed images of the liver and two such delayed images were performed.

IMPRESSION: No definite hepatic lesion found.
The atelectasis is probably where I didnt take a deep enough breath during the scan according to Dr. google :lol:

The area where the possible artifact is appears to be right where the clips are from my gallbladder removal so I bet it has something to do with that. At any rate all is well and that is all that matters.

Last edited by BoxerIsis; 08-05-2010 at 09:10 AM.

 
Old 08-05-2010, 01:22 AM   #9
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Re: Focal soft tissue nodule

glad it all showed up fine, I presume they couldn' t see the liver nodule that they thought they saw before
Mc

 
Old 08-05-2010, 02:08 AM   #10
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BoxerIsis HB User
Re: Focal soft tissue nodule

Nope no nodule or lesion of any sort. Apparently the u/s just saw a "ghost" of some sort.

 
Old 09-16-2010, 07:30 PM   #11
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Re: Focal soft tissue nodule *Update need biopsy*

My liver enzymes have continued to be elevated so the next step is to have a biopsy which will be done on the 23rd of this month. I am nervous about the procedure and about what it might show. Could be an autoimmune issue

Last edited by BoxerIsis; 10-01-2010 at 04:24 AM.

 
Old 09-16-2010, 11:25 PM   #12
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JCAllison HB User
Re: Focal soft tissue nodule *update post #8*

Quote:
Originally Posted by BoxerIsis View Post
I know this is a very long post but I am hoping for help and I want to make sure I get everything important down.
Hey Ms. B,
Might I suggest that when you write detailed information that you don't abbreviate. This would be helpful to avoid any misunderstanding.

Quote:
I am 38yo 5'-'7" and weigh 197pds. I found out yesterday through u/s that I have a Focal soft tissue nodule on the right lobe measuring 1.5cm.
I'm assuming that this is the right lobe of your liver.

Quote:
I didnt ask the Dr. What it could be.
A tip on when you meet with your physician. Take a notebook and write down what he tell you. This will remind you to get clarification on what he says and what the "gastroese" terminology means.

Quote:
and now wish I had since I woke at 2AM and proceeded to have a panic attack that hasnt fully left me yet
If you are prone to panic attacks, it wouldn't hurt to tell your Primary Care Physician (PCP) that you are having them. Your PCP can prescribe medication specifically for them.

Quote:
The report I got: I have been googling and havnt found much that is easy to understand.
It takes a bit of doing this to get the hang of the meaning. It's an acquired skill.

Quote:
I of course am terrified it is cancer but it appears that cancer is not that common or at least not something to think of right away?
It is quite unusual for cancer to just all of a sudden to appear on one's liver.

Quote:
It all started back in Dec. last year when I had bw done because of my high blood pressure to check my cholesterol and triglycerides. The bw showed that 2 of my liver enzymes where off but the Dr. felt that my risk for not taking cholesterol med, vitoryn, was less than not treating my very high chol. and tri. levels. I reluctantly agreed to take the med knowing that no one in my family have ever been able to take a statin. By week 3 on it my muscles where so sore I couldnt even load the dishwasher so stopped the med and went back in for bw.
There is a much better way to deal with cholesterol. You've seen the commercials on the telly about Cheerios helping to lower cholesterol? Well, that's a somewhat effusive play on the fact that fibre in one's diet helps to "soak" up cholesterol. And Oats are a source of fiber. But, if one is serious about this, probably the BEST fiber is Psyllium Husk. It comes in various products such as Colon Cleanse. A scoop in twelve ounces of water followed by another twelve ounces of water every morning had in less than a year gotten my cholesterol down to optimum levels. Also resulted in lower blood pressure, and increased regularity, and all without any chemicals which is much gentler on the liver.

Quote:
It showed that my muscles where being damaged as well as my liver enzymes where elevated even more.
Psyllium Husk won't do either of those things. It is available from Nutritional Centers, and Health Food Stores, and is quite affordable. Even more so if bought in bulk which is available from many websites.

Quote:
Here are the liver enzyme readings that I have gotten over the last 8 months:
12/07/09 before starting the Vytorin:

AST (SGOT) 49 Normal level (4-34)
ALT (SGPT) 70 Normal level (0-55)
These are nominal. The important thing to note is that they are elevated in the first place.

Quote:
1/21/10 After having been on the Vytorin for just shy of a month
AST (SGOT) 53
ALT (SGPT) 85
These are at the upper level of nominal. But the important thing to note is that they are going up.

Quote:
Creatine Kinase 146
Am unfamiliar with Creatine Kinase.

Quote:
1/26/10
AST (SGOT) 47
ALT (SGPT) 84
Leveled off in one week. Did you do anything differently that week.

Quote:
2/08/10
AST (SGOT) 38
ALT (SGPT) 58
A downward trend.

Quote:
/10/10 (Dr. decided to add some more tests here)
AST (SGOT) 47
ALT (SGPT) 65
A bit of a bump. This can be caused by test error margin, and maybe alcohol intake.

[quote]4/15/10 (Results from the Rhumatologist bw)
AST (SGOT) 61
ALT (SGPT) 85

Back up to upper limits of nominal.

Quote:
7/8/10 (last set of bw)
AST (SGOT) 70
ALT (SGPT) 90
Another upward trend. Ms. B, it is also good to be aware that AST and ALT, while used to track liver tissue destruction, can also be a sign of heart and muscle tissue destruction. It might be a good idea to get a specific Liver Function Panel Blood Test.

Quote:
I had my thyroid removed back in 96 due to cancer and have been fine since then. So I do have a cancer history
That was fourteen years ago. Still it could be a factor, but a minimal one.

Quote:
If anyone has any thoughts or could tell me what to search for that would be great because I am not having much luck. I dont know when my CT scan will be the Dr. office has to schedule it and they are so slow about things like that. In the mean time I get to worry myself sick.
This is the logical thing to do. Don't be reticent to encourage your physician to attend to this matter ASAP. Be gentle but firm with them. Explain that you are concerned, and anxious.

I happen to be a twelve year survivor of the autoimmune liver disease: Primary Biliary Cirrhosis (PBC) that generally kills in five to six months. I can sympathize with your anxiety, but taking good care of yourself, watching your diet, cultivating a good relationship with your physician, maintaining a good attitude, and learning all you can about everything that you don't already know about produces a somewhat less anxious demeanor. I have come to, over the years, describe the process as maybe not always pleasant, but NEVER uninteresting. Make your survival and level of health a major project in your life.

Three other things that you might encourage you physician to check into is your Prothrombin Time with International Normalized Ratio (INR), Bilirubin Direct, and Creatinine. With these three scores you can check what is called MELD Score. Then Google "MELD" and you will find pages that will calculate your MELD Score just by entering the test numbers. You can take some amount of comfort if your MELD Score is 7 or lower, for that is an indication that your liver functioning is well within what is acceptable.

HTH

JC

 
Old 09-16-2010, 11:39 PM   #13
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JCAllison HB User
Re: Focal soft tissue nodule

Quote:
Originally Posted by BoxerIsis View Post
My liver enzymes have continued to be elevated so the next step is to have a biopsy which will be done on the 23rd of this month.
Hey Ms. B,
Have they done Liver Function and Basic Metabolic panels. Have they checked for Anti-Nuclear Anti-Bodies (ANA) and Anti-Mitochondral Anti-Bodies (AMA)?

Quote:
I am nervous about the procedure
It's a simple procedure, not painless, but bearable.

Quote:
and about what it might show.
Understandable. The unknown is always stressful.

Quote:
Could be an autoimmune issue
It could very well be, BUT... When they found the PBC that I have, my AST and ALT number were up in the 300 range and that was still nominal as some doesn't get found untill they are up in the 2,500 range. What this means is that IF in fact you have one of the Autoimmune Hepatitis issues, that they have caught it VERY early, and you can take some amount of comfort in THAT. Still, the Focal Soft Tissue Nodule is NOT one of the symptoms of an Autoimmune Hepatitis issue.

Try to dial back the worry and anxiety. Take solace that you are on top of this situation. Be determined to learn all that is knowable about it, and become a veteran at it. It has a calming effect on ones attitude.

HTH

JC

 
Old 09-17-2010, 04:41 AM   #14
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BoxerIsis HB User
Re: Focal soft tissue nodule *Update nodule just fat*

He told me the nodule was not anything to be concerned about at all and was just fat deposited in more concentrated areas. So I am no longer concerned about that. He never mentioned anything about an autoimmune issue being life threatening at all just how it would be treated with meds.

He did say that he expected to find a non specific cause of liver inflammation but did did not say what treatment would be. I am overwhelmed and frankly terrified now that I know it could still be something that could take my life

I am trying my hardest not worry but with my issues I cant stop it.

This is the full hepatic function panel tests from 12/07 up to

Albumin, Serum 4.4
Billirubin, Total 0.4
Billirubin, Direct 0.2
Alkaline Phosphates 99
AST 49
ALT 70

1/21
Albumin, Serum 4.1
Billirubin, Total 0.6
Billirubin, Direct 0.2
Alkaline Phosphatase S 97
AST 53
ALT 85

1/26
Albumin, Serium 4.3
Billirubin, Total 0.5
Billirubin, Direct 0.2
Alkaline Phosphatase, S 104
AST 47
ALT 84

2/08
Albuim, Serum 4.4
Billirubin, Total 0.8
Billirubin, Direct 0.2
Alkaline Phosphatase, S 90
AST 38
AST 58

2/10
Albuim, Serum 4.4
Billirubin, Total 0.6
Alkaline Phosphatase, S 98
AST 47
AST 65
Aldolase 9.2

4/20
Albuim, Serum 4.0
Alkaline Phosphatase, S
AST 61
AST 85
Aldolase 9.8

7/12
Albuim, Serum 4.2
Billirubin, Total 0.5
Billirubin, Direct 0.3
Alkaline Phosphatase, S 99
AST 70
ALT 90

So out of those only my AST and ALT have been elevated. But this Dr. who is a liver specialist felt that with the high protein and the other things that the biopsy was the next logical step.

So obviously something is wrong it is just a matter of how wrong. He actually didnt even mention the autoimmune thing until I asked him for worst case scenerio.

Last edited by BoxerIsis; 10-01-2010 at 04:25 AM.

 
Old 09-17-2010, 03:50 PM   #15
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Re: Focal soft tissue nodule

Quote:
Originally Posted by BoxerIsis View Post
He told me the nodule was not anything to be concerned about at all and was just fat deposited in more concentrated areas. So I am no longer concerned about that.
Hey Ms. B,
GREAT! One down, more to go.

Quote:
He never mentioned anything about an autoimmune issue being life threatening at all just how it would be treated with meds.
Alright. But YOU, and your physician should remain aware of any autoimmune issue. As I mentioned previously, my PBC was caught just as it had started. And it was quite by accident, for I was going to have a hip replacement, and the lab tests to see what the Prothrombin Time (the time it takes one's blood to clot), was, and they found it was elevated. That prompted more tests, which revealed AST was 268. ALT was 358.

The Medications of choice for autoimmune liver issues is Prednisone, Azathioprine, and Ursodeoxycholic Acid. I've been on all three for almost twelve years.

Quote:
He did say that he expected to find a non specific cause of liver inflammation but did did not say what treatment would be.
The lab test will direct them to the diagnosis. The biopsy is to confirm or not confirm the diagnosis.

Quote:
I am overwhelmed and frankly terrified now that I know it could still be something that could take my life I am trying my hardest not worry but with my issues I cant stop it.
I know what you mean. But you will look back at the worrying you are doing now and see that it was much to early to let this upset you.

Quote:
This is the full hepatic function panel tests from 12/07 up to

Albumin, Serum 4.4
Billirubin, Total 0.4
Billirubin, Direct 0.2
Alkaline Phosphates 99
AST 49
ALT 70
All of these are within the Latest Range except for the AST and ALT which are minimally elevated.

Quote:
1/21
Albumin, Serum 4.1
Billirubin, Total 0.6
Billirubin, Direct 0.2
Alkaline Phosphatase S 97
AST 53
ALT 85
Likewise with these scores.

Quote:
1/26
Albumin, Serium 4.3
Billirubin, Total 0.5
Billirubin, Direct 0.2
Alkaline Phosphatase, S 104
AST 47
ALT 84
Likewise with these.

Quote:
2/08
Albuim, Serum 4.4
Billirubin, Total 0.8
Billirubin, Direct 0.2
Alkaline Phosphatase, S 90
AST 38
AST 58
Likewise with these.

Quote:
2/10
Albuim, Serum 4.4
Billirubin, Total 0.6
Alkaline Phosphatase, S 98
AST 47
AST 65
Aldolase 9.2
Likewise with these. (I have no reference on any of my tests for Aldolase.)

Quote:
4/20
Albuim, Serum 4.0
Alkaline Phosphatase, S
AST 61
AST 85
Aldolase 9.8
Likewise with these.

Quote:
7/12
Albuim, Serum 4.2
Billirubin, Total 0.5
Billirubin, Direct 0.3
Alkaline Phosphatase, S 99
AST 70
ALT 90
Likewise with these.

Quote:
So out of those only my AST and ALT have been elevated. But this Dr. who is a liver specialist felt that with the high protein and the other things that the biopsy was the next logical step.
A biopsy is just another test.

Quote:
So obviously something is wrong it is just a matter of how wrong.
At this point Ms. B, worrying is not something that you NEED to do. Be apprehensive and watchful, but if this is actually going to be a serious issue, you have years yet to go. All kinds of OTHER things are as or more serious than this right now. Besides, with the way science is progressing, they may find a cure for all this stuff in the foreseeable future.

Quote:
He actually didnt even mention the autoimmune thing until I asked him for worst case scenerio.
There are too many factors involved for you to worry unduly. My advice is to take a step back, take a deep breath, and make a resolution that you will take each situation as it comes without despairing.

I had a nurse tell me that no one REALLY knows how much time one has left, and that it was her conviction that one could not go until one had finished here.

The next time I saw her, I told her that I went home, made out a list of all the things I have to do, and at the rate that I'm getting them done, if I can't go till I'm finished, that I just may live forever!

Hope you are feeling well.

JC

 
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