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What are the findings from the ultrasound and CT scan reports?

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General & Family Physician
Practicing since : 2008
Answered : 641 Questions
Hi, My MOM was having symptoms of Fever spikes, pain abdomen & nausea since 2 week. Doctors Diagnosis was : ?GALL BLADDER NEOPLASTIC RESION USG IMPRESSION: Grossely thick walled GB with few calculi and sludge/mass lesion. Few enlarged lymphnode(largest one is about 12 mm.X 10mm) size at porta hepatis. CT Scan with contrast report: the gall bladder is contracted and thick walled showing prominent asymmetrical wall thickening of 16 mm size involving body showing lost fat plane with adjacent liver ans 1st part of duodenum. The fat plane is also ill defined with adjacent hepatic flexure. Small loculated collection is seen medial to GB and another ill defined hypo-echoic collection antero-inferior to GB.Mild adjacent fat stranding and few mesenteric lymph nodes also seen. There is minimal IHBR dilatation involving left lobe of lever. CBD is not dilated. No other focal liver lesion seen. pancreas is normal and pancreatic duct not dilated. Spleen is normal showing no focal lesion. Both adrenals are normal. both kidneys are enhancing normally. Bowel loops no dilated. Urinary bladder is normal.No large pelvic mass. OPINION: The CT imaging findings are highly suspicious of gall bladder neoplastic lesion, most likely malignant with possible liver and duodenal invasion and suspected invasion of hepatic flexure. Small loculated collection is seen medial to GB and another ill defined hypo-echoic collection antero-inferior to GB. This finding is suspicious of associated GB perforation. Doctors given antibiotic treatment and she were ok, and the symptoms didn't seen.But from last three days light fever spikes are again seen, no other symptoms are seen. Kindly suggests me the possible solution of this.
Posted Thu, 6 Feb 2014 in Liver and Gall Bladder
Answered by Dr. Gaurav Katiyar 1 hour later
Brief Answer: Suggestive of Cholecystitis Detailed Answer: Hi, I have gone through your query. From the blood reports and symptoms it seems that your mother is suffering from Acute cholecystitis with gall stones. CT scan and Ultrasound reports suggests that it is a gall bladder cancer which has spread to locally to duodenum, liver and surrounding lymph nodes. But this type of cancer is very rare. As symptoms disappear after Antibiotic course, it is an infection. But fever again spiked, this means that infection is not fully treated. From all this history and treatment, I advise her to go for: 1)Antibiotic course with broad Spectrum antibiotics like Piperacillin and tazobactum for 10-15 days. 2) Complete blood count after treatment. If There is no sign of infection in blood report, go for a USG guided FNAC of GB and Surrounding Lymph nodes. 3) If no cancer is found, then wait if symptoms arise again. In this case surgical removal of Gall bladder is advised. 4) If there is cancer, Staging will be done, and depending on that treatment will be decided. Final decision will be of your treating doctor. Hope I have answered your query. If you have any further questions I will be happy to help.
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Follow-up: What are the findings from the ultrasound and CT scan reports? 1 hour later
Is there any oral treatment like tablets/capsules. Earlier Doctor advised her these medicine: during hospitalization neksium 40mg taziza lyo 4.5 mg dynapar-aq iv zanocin oz zester kit 1 gm with ns ondem 1amp after hospitalization neksium 40 mg moxif 400mg zanocin-oz tab
Answered by Dr. Gaurav Katiyar 33 minutes later
Brief Answer: These can be continued Detailed Answer: Hi, Thanks for the follow up. I had advised Taziza injection but it should be given under supervision of Healthcare professional. Yes, You can continue medicines prescribed after discharge of you mother. Moxif and Zanocin -OZ are antibiotics and Neksium is a proton pump inhibitor to prevent acidity. These can be extended to 10 days more and after that go for a CBC (Complete Blood count). Paracetamol can be given when needed for fever. If you do not have any clarifications, you can close the discussion and rate the answer. Wish her good health.
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