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Having symptoms of tiredness. Blood test showed high liver enzymes. Found hypoechoic liver lesion and borderline spenomegaly

May 2014
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Practicing since : 2002
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I visited my general physician with symptoms of tiredness and just not feeling well. I had blood work done and the results showed high liver enzymes. The test were repeated with the addition of an abdominal sonogram. The results were again elevated enzymes and 1.5 cm hypoechoic liver lesion and borderline spenomegaly. I am a physically fit 168 pound 41 year old caucasion male with a relatively healthy past. I have an appt with a liver specialist but it will not take place for a week. I do understand without further test there cannot be any definite prognosis but would like to have an idea of the likelyhood of malignancy based on experience or medical studies. Thanks for your time.
Posted Thu, 24 Oct 2013 in Liver and Gall Bladder
Answered by Dr. Vivek Chail 4 hours later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Hi XXXXXXX whitehead,
Thanks for writing in to us.

I have read through your query in detail.

Your blood reports show elevated AST, ALT and Alkalikne Phosphatase. This can happen in many disease conditions. You GGT is also marginally raised. Any significant alcohol intake history might also show elevated liver enzymes.

Going by your ultrasound scan findings, there is a mention of a 1.5 cm diameter hypoechoic (black on image) lesion in right lobe of liver with XXXXXXX Color uptake on Doppler which defines it as an area of increased blood supply. There is also mild splenomegaly (13.9 cms). Other than above there is a small speck of calcification in right kidney (not significant).

Speaking of the liver lesion in details, the lesion is seen as a subtle area showing increased blood flow. It is very small to characterise it purely based on ultrasound findings. That is the reason a MRI scan has been suggested for you. The likelihood of malignancy in such a lesion is less likely but further investigation is needed to confirm the real nature of the lesion.

In my experience a single 1.5 cms lesion surely needs to be followed up for any significant change in size and development of new lesions. A study has shown that malignancy is better picked up on CT scan or MRI scan of liver than in ultrasound (even for lesions smaller than 3 cms). This is based on contrast enhancement characteristics as studied by CT and MRI scan.

The commonest hypervascular lesion occurring in liver is hemangioma which is a benign lesion.

Hope your query is answered.
Do write back in case of doubts.

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