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What Does This Ultrasound Report Indicate?
Question: Hello doctor..What does my ultrasound report indicates ?what should be my next course of action?what is meant by this subcutaneous Edema and what could be the reasons for this and what is the differential diagnosis?whom can I consult with regard to my line of my treatment
Brief history
C sec delivery 1.5 years back in nov 14 ,post that 1 year att was taken from april 14 to april 15...attaching both latest as well as earlier reports..i will be greatful if u can pls help me with my problem..pls guide in detailed manner
Brief history
C sec delivery 1.5 years back in nov 14 ,post that 1 year att was taken from april 14 to april 15...attaching both latest as well as earlier reports..i will be greatful if u can pls help me with my problem..pls guide in detailed manner
Brief Answer:
Ultrasound interpretation
Detailed Answer:
good morning XXXXXXX
I have gone through your reports..
I would like. to know a few more details before I can guide you further:
1. was it a routine follow up ultrasound or you had any symptoms
2. I saw your last report.. it seems you had developed a fabulous tract.. for which ATT was given.. It is very unusual to have such a tract. I am suspecting it may have been a complication of caserean..
3. we're there any tests done for Tb that time or it was given on the basis of that report...
This edema doesn't look too specific to me.. More. of an objective finding... and it can happen after the healing of this tract or even after caserean....
Do let me know these queries.. Would guide you further from. here
regards
Dr naval
Ultrasound interpretation
Detailed Answer:
good morning XXXXXXX
I have gone through your reports..
I would like. to know a few more details before I can guide you further:
1. was it a routine follow up ultrasound or you had any symptoms
2. I saw your last report.. it seems you had developed a fabulous tract.. for which ATT was given.. It is very unusual to have such a tract. I am suspecting it may have been a complication of caserean..
3. we're there any tests done for Tb that time or it was given on the basis of that report...
This edema doesn't look too specific to me.. More. of an objective finding... and it can happen after the healing of this tract or even after caserean....
Do let me know these queries.. Would guide you further from. here
regards
Dr naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank u so much for the reply doc,
I will tell u all the details
I had a cesarean delivery on 17 Nov 14.in a span of one week I developed severe redness on my strech marks which was very tender to touch.some med were given by my operating doc nd then was referred to a skin specialist who said its part of healing process .then I went to so many docs in Dec but nothing worked .everybody was like it happens after cesaraen,but my discomfort was not going..i used to have mild fever severe constipation cough bloating alternative diroeha) also ..my stomach was so flabby and tender to touch...then in XXXXXXX I changed my gynae nd she said this has been a severe infection nd I was admitted nd given antibiotics(amikacin nd pipzo) thru iv..it subsided for a week and again resurfaced.i was then treated for cellulitis by a XXXXXXX gynae..but again the problem kept on resurfacing..various antibiotics were tried but in wane ..the problem used to resurface.
Then in month of Feb when an ultrasound was conducted tb was diagnosed by the radiologist,but again no one belived as my chest x ray and tb gold came negative..everybody refused to give att and said that these sinus can dwvlop post any major surgery..then an mri was done that showed adhesions also(enclosing the report).
Finally a doc started to give empirical att mantoux and igra test came positive..on 1st April 15 att (akt 4 was started)..in follow up of XXXXXXX usg tht track got healed..but July august onwards I had started feeling discomfort on left side also..as soon as I left att in April 16 the swelling resurfaced this XXXXXXX with more discomfort on left side ...
Now the radiologist doc who conducted usg is very much sure of this being a case of cellulitis in subcutaneous fat nd reoccuren e of kochs. ...nd now I feel again feverish with chills nd discomfort again in my abdomen....completely helpless as what to do next..
Pls if u can be my guide nd help me I will be very greatful..attaching my latest blood work nd old mri report sir
I will tell u all the details
I had a cesarean delivery on 17 Nov 14.in a span of one week I developed severe redness on my strech marks which was very tender to touch.some med were given by my operating doc nd then was referred to a skin specialist who said its part of healing process .then I went to so many docs in Dec but nothing worked .everybody was like it happens after cesaraen,but my discomfort was not going..i used to have mild fever severe constipation cough bloating alternative diroeha) also ..my stomach was so flabby and tender to touch...then in XXXXXXX I changed my gynae nd she said this has been a severe infection nd I was admitted nd given antibiotics(amikacin nd pipzo) thru iv..it subsided for a week and again resurfaced.i was then treated for cellulitis by a XXXXXXX gynae..but again the problem kept on resurfacing..various antibiotics were tried but in wane ..the problem used to resurface.
Then in month of Feb when an ultrasound was conducted tb was diagnosed by the radiologist,but again no one belived as my chest x ray and tb gold came negative..everybody refused to give att and said that these sinus can dwvlop post any major surgery..then an mri was done that showed adhesions also(enclosing the report).
Finally a doc started to give empirical att mantoux and igra test came positive..on 1st April 15 att (akt 4 was started)..in follow up of XXXXXXX usg tht track got healed..but July august onwards I had started feeling discomfort on left side also..as soon as I left att in April 16 the swelling resurfaced this XXXXXXX with more discomfort on left side ...
Now the radiologist doc who conducted usg is very much sure of this being a case of cellulitis in subcutaneous fat nd reoccuren e of kochs. ...nd now I feel again feverish with chills nd discomfort again in my abdomen....completely helpless as what to do next..
Pls if u can be my guide nd help me I will be very greatful..attaching my latest blood work nd old mri report sir
Brief Answer:
Subcutaneous edema
Detailed Answer:
Good evening XXXXXXX
Well, it s a complicated case...Although, i am not a gynaecologist, I discussed the case with my wife as well...
There are a few things we need to look at:
1. Your findings during surgery are essential, as we can figure out if you had adhesion's that time or not. But either ways, you have taken the treatment for tuberculosis. So the next possibility comes, whether it is an untreated tuberculosis which is refractory to treatment, since you were doing good on ATT and it recurred when you stopped.
But how long to take ATT, we can only know by getting a tissue sample..Maybe from the endometrium or from the tissues inside. It will be a bit invasive but nothing beats the Biopsy report..which is a gold standard
2. The other possibility is some inflammatory reaction going on. It can happen due to proline which is used for stitching as well..Since the edema keeps coming up in your tissue..
I would suggest you consult a plastic surgeon as well apart from gynae..As all the uterus, tubes are fine we need to see what structure is triggering it. Inflammatory or infective...CRP is only mildly raised which goes against any infection...
So I think take another opinion of a plastic surgeon. Once we have ruled out infection, we can give a short trial of steroids to help the edema subside...
Hope the information was a bit useful
Do let me know for more queries...Will guide you further
REgards
Dr Naval
Subcutaneous edema
Detailed Answer:
Good evening XXXXXXX
Well, it s a complicated case...Although, i am not a gynaecologist, I discussed the case with my wife as well...
There are a few things we need to look at:
1. Your findings during surgery are essential, as we can figure out if you had adhesion's that time or not. But either ways, you have taken the treatment for tuberculosis. So the next possibility comes, whether it is an untreated tuberculosis which is refractory to treatment, since you were doing good on ATT and it recurred when you stopped.
But how long to take ATT, we can only know by getting a tissue sample..Maybe from the endometrium or from the tissues inside. It will be a bit invasive but nothing beats the Biopsy report..which is a gold standard
2. The other possibility is some inflammatory reaction going on. It can happen due to proline which is used for stitching as well..Since the edema keeps coming up in your tissue..
I would suggest you consult a plastic surgeon as well apart from gynae..As all the uterus, tubes are fine we need to see what structure is triggering it. Inflammatory or infective...CRP is only mildly raised which goes against any infection...
So I think take another opinion of a plastic surgeon. Once we have ruled out infection, we can give a short trial of steroids to help the edema subside...
Hope the information was a bit useful
Do let me know for more queries...Will guide you further
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks for ur reply sir,
i really appreciate ur advice but my dilemma is that whether any surgicalnintervention be it biopsy or reconstructive surgery will either manifest my problem as the radiologist saidvthat these intervention ,may create even more sinus and fistuals which would be very difficult to treat
as per his opinion this has been an inappropriate treatment with regard to mybweight and duration(wen treatment started i weighed 69 kg was given akt4 for 3 months ,then aktb3 for 4 months and akt 2 for 5 m8nths)
sir if this is a case of skin tb can a de4matalogist opinion bebtaken
3. as u said this might be a suture reaction what can be done for that
4 this is indeed a complication of ceasaraen as i wasnt operated properly
5.can u suggest me some highlybexperienced tb or infectious disese specialist whoncan handle th7s case..i belong to XXXXXXX
6.what can be done for this subcutaneous edema forbthe time ,..i have completed a course of cefi xl d for 10 days just yesterday..i m afraid that if this is cellulitis it will again make my situation even more complicated ..i feel difficiluty in my left abdominal area atbthe site of adhesions..itbfeels like stuck and a small lump kind wit h slight feverish feeling and chills
ibforgot tovtell ubthat while taking att i didnt have my periods for approx 10 months had viral conjuctivitis keratitis and herpes zoster also on my arm in march 16
pls guide sir,feeling helpless
i really appreciate ur advice but my dilemma is that whether any surgicalnintervention be it biopsy or reconstructive surgery will either manifest my problem as the radiologist saidvthat these intervention ,may create even more sinus and fistuals which would be very difficult to treat
as per his opinion this has been an inappropriate treatment with regard to mybweight and duration(wen treatment started i weighed 69 kg was given akt4 for 3 months ,then aktb3 for 4 months and akt 2 for 5 m8nths)
sir if this is a case of skin tb can a de4matalogist opinion bebtaken
3. as u said this might be a suture reaction what can be done for that
4 this is indeed a complication of ceasaraen as i wasnt operated properly
5.can u suggest me some highlybexperienced tb or infectious disese specialist whoncan handle th7s case..i belong to XXXXXXX
6.what can be done for this subcutaneous edema forbthe time ,..i have completed a course of cefi xl d for 10 days just yesterday..i m afraid that if this is cellulitis it will again make my situation even more complicated ..i feel difficiluty in my left abdominal area atbthe site of adhesions..itbfeels like stuck and a small lump kind wit h slight feverish feeling and chills
ibforgot tovtell ubthat while taking att i didnt have my periods for approx 10 months had viral conjuctivitis keratitis and herpes zoster also on my arm in march 16
pls guide sir,feeling helpless
Brief Answer:
Further queries
Detailed Answer:
Good evening XXXXXXX
Well, no doubt your case is complicated. I think you need a team of doctors to sort it out...Best way out is to visit a multi specialty hospital and get it evaluated. SO once everyone has a look into it, at least one can draw the conclusion as to where we are heading.
1. I wont suggest a dermatologist opinion as it doesnt look like a skin case. The adhesion's you had probably were present even before the cesarean took place or may have been created later. Kinda hard to say. But still you took adequate treatment for it. So incase it is a resistant one, then things may have to change.
That is the 2nd line for tuberculosis
2. For suture reaction if it is, we need a course of anti allergics along with low dose steroids for a short course.
3. I work in medanta hospital. I would suggest you can visit here...Take an opinion of :
1. Dr XXXXXXX RAo( INternal MEdicine)--> He is highly qualified and most experienced guy with infections
2. Dr Sabhyata Gupta: Gynaecologist
3. Dr XXXXXXX Khazanchi: PLastic Surgeon
For now, lot of people are giving different opinion as noone is consulting each other to what possible the outcome may be. This is where you are getting lost. So one needs to work together and sort it out for you..
LAstly, I wont suggest any more antibiotic course.. Just chart your fever and take crocin on SOS basis...PRolonged antibiotics will make your body more resistant to the organisms.
Do let me know if I can be of any more help. If needed get admitted for a couple of days to sort it out...
REgards
Dr Naval
Further queries
Detailed Answer:
Good evening XXXXXXX
Well, no doubt your case is complicated. I think you need a team of doctors to sort it out...Best way out is to visit a multi specialty hospital and get it evaluated. SO once everyone has a look into it, at least one can draw the conclusion as to where we are heading.
1. I wont suggest a dermatologist opinion as it doesnt look like a skin case. The adhesion's you had probably were present even before the cesarean took place or may have been created later. Kinda hard to say. But still you took adequate treatment for it. So incase it is a resistant one, then things may have to change.
That is the 2nd line for tuberculosis
2. For suture reaction if it is, we need a course of anti allergics along with low dose steroids for a short course.
3. I work in medanta hospital. I would suggest you can visit here...Take an opinion of :
1. Dr XXXXXXX RAo( INternal MEdicine)--> He is highly qualified and most experienced guy with infections
2. Dr Sabhyata Gupta: Gynaecologist
3. Dr XXXXXXX Khazanchi: PLastic Surgeon
For now, lot of people are giving different opinion as noone is consulting each other to what possible the outcome may be. This is where you are getting lost. So one needs to work together and sort it out for you..
LAstly, I wont suggest any more antibiotic course.. Just chart your fever and take crocin on SOS basis...PRolonged antibiotics will make your body more resistant to the organisms.
Do let me know if I can be of any more help. If needed get admitted for a couple of days to sort it out...
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks doc
but if possible can unpls suggest some other option apart from medanta as firstly i cant afford that and moreover i dont have gud past experience ,so some other govt institutte like XXXXXXX e or expereinec infectious disease specialist in XXXXXXX
but if possible can unpls suggest some other option apart from medanta as firstly i cant afford that and moreover i dont have gud past experience ,so some other govt institutte like XXXXXXX e or expereinec infectious disease specialist in XXXXXXX
Brief Answer:
Doctors reference
Detailed Answer:
Good evening XXXXXXX
Sorry for the late reply.. Just been baby sitting
Sorry about your bad experience with medanta.. Well, as such infectious disease specialist are not too many in XXXXXXX In medanta we have Dr XXXXXXX ..But mostly medicine people look after it...Since you are in XXXXXXX you can consult Dr Kalra at Fortis Shalimar bagh. I got it from a few references that he is good..
XXXXXXX and all you will be lost again as the waiting will be too much and there is no definite coordination. RML has one of the best medical team if u wanna visit. You can meet Dr XXXXXXX there as well...
But somewhere I feel you need a combined team review rather than an individual one. I understand financial constraints, but you are already spending so much to sort things out..
Do let me know for more queries. Would do my best to sort it out for you
Regards
Dr Naval
PS: I discussed your case with my mother in law as well. She is gynaecologist head in XXXXXXX action. She has advised for a sinogram to locate the sinus... You can consult her for an opinion as well...
Doctors reference
Detailed Answer:
Good evening XXXXXXX
Sorry for the late reply.. Just been baby sitting
Sorry about your bad experience with medanta.. Well, as such infectious disease specialist are not too many in XXXXXXX In medanta we have Dr XXXXXXX ..But mostly medicine people look after it...Since you are in XXXXXXX you can consult Dr Kalra at Fortis Shalimar bagh. I got it from a few references that he is good..
XXXXXXX and all you will be lost again as the waiting will be too much and there is no definite coordination. RML has one of the best medical team if u wanna visit. You can meet Dr XXXXXXX there as well...
But somewhere I feel you need a combined team review rather than an individual one. I understand financial constraints, but you are already spending so much to sort things out..
Do let me know for more queries. Would do my best to sort it out for you
Regards
Dr Naval
PS: I discussed your case with my mother in law as well. She is gynaecologist head in XXXXXXX action. She has advised for a sinogram to locate the sinus... You can consult her for an opinion as well...
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Above answer was peer-reviewed by :
Dr. Prasad
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