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CT scan report showed solid organ evaluation limited without contrast. What does this mean?

Apr 2013
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General Surgeon
Practicing since : 2008
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I recently had a CT scan done at my hospital I use and received my report. I really don't know what I'm reading so I need some clarification. I do have stage 2 kidney disease and history of stones. The report is as follows:
Findings: Study limited without IV contrast. Visualized portions of lung bases unremarkable. Heart is not enlarged. Mild elevation of right hemidiaphragm. Liver, spleen, adrenals grossly unremarkable without contrast. No pericholecystic stranding, and no bilitary ductal dilatation. No peripancreatic stranding. Mildy lobulated renal contour. Indeterminate small hypodense renal lesions with small right hypodense lesion with peripheral calcification. Bilateral punctuate nonobstructing stones. No hydronephrosis. Bladder moderately distended. Prostate mildly prominent. Subcentimeter retroperitoneal, mesenteric lymph nodes. Aorta is not aneurysmal. Right-sided IVC. Small hiatal hernia. Appendix unremarkable without stranding. Colonic haustra and or diverticulum without stranding. Rectosigmoid wall prominence or due to incomplete distention. No free fluid, no free air, no gross bowel obstruction. Tiny umbilical hernia with fat. Mild degenerative changes in the spine. Probable bone island in right femur.
IMPRESSION: Solid organ evaluation limited without contrast. Bilateral renal nonobstructing stones. Indeterminate hypodense renal lesion right hypodense lesion with peripheral calcification, suggest focused renal ultrasound with color Doppler and/or contrast CT followup for better evaluation if clinically warranted. PRIMARY DIAGNOSTIC CODE: Significant abnormality, attn needed.

So there you go. Sorry for the long report but I have little clue as to what all this means. My followup doctor appointment isn't untill July and they do not answer questions on the phone or email. I have to wait. Please let me know what I have going on according to this report, in lamemin terms. Thank you.
Posted Mon, 10 Jun 2013 in X-ray, Lab tests and Scans
Answered by Dr. Ivan R. Rommstein 2 hours later
Hi and welcome to XXXXXXX

Thank you for your query.

Mild elevation of hemidiaphragm is normal finding and it doesn’t indicate anything and doesn’t cause any difficulties. No stranding means that there ii no sign of inflammation of your abdominal organs.
Lobulated renal contour indicates chronic and cystic changes of kidney and it can be resulting from those hypodense lesions which are described.

"Indeterminate small hypodense renal lesions with small right hypodense lesion with peripheral calcification". - This is pathology, but as they said they can’t determine the exact cause. CT can see mass and its density, but it can’t verify is it benign tumour, cyst, carcinoma, hydronephrosis, infections, abscesses or something else as all these lesions can be hypodense.

Of course, malignancies must be ruled out and this is why they recommended Doppler ultrasounds which can verify is this lesion vascularized (if yes then this isn’t good sign). From my experience, since there is no sign of infiltration, bleeding, expansion, metastasis, renal dysfunction or hydronephrosis, this is not suggestive of malignant tumour and it seems like kidney cyst or benign tumour. Cysts are often seen on CT and most of them are small and not significant, but sometimes it can grow and cause complications such as bleeding, infection or malignant alteration.

You didn’t mention do you have any symptoms, blood in urine and pain in lumbar area, kidney functional tests? If all this is normal you don’t have to be concerned. Also you didn’t mention did they find they the cause of stage 2 kidney diseases in such young patient as you are. These renal lesions can be cause of it, but some other should be considered such as diabetes, glomerulonephritis or chronic renal failure. Considering those stones you can expect renal colics in future so drink enough fluids, special teas, lemon juice. Limit food containing oxalate and high protein food.

All in all, you can be relaxed, don’t need to hurry with those tests, but it should be done just to clear this out and evaluate is there size progression (so do ultrasound check up every 4-6 months). If there will be any doubt about malignancy then biopsy should be performed, but I think that you need only frequent follow up and that’s all.

Wish you good health. If you have anything to ask, I ll be glad to help .
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