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Spinal lesion found on MRI, bladder infection, POTS, normal renin, high aldosterone, ambulatory blood pressure test, abnormal ESR, CT scan, inflammation. Cancer?.

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Spinal lesion found on MRI
Hi, I'm a 32 year old woman and my doctor told me that a spinal lesion was seen on a recent MRI I got. This MRI was to investigate a lesion found on my liver, which turned out to be FNH. I have been dealing with a multitude of health problems in the past two years. Please read my history to put this result into context. I've had several abnormal blood tests in the past two year and recently.
Please look here : Hello, I hope you can help me make sense of some symptoms I've been experiencing for the past couple of months and some test results I have been given. I'm a 32 year old female
and I haven't been feeling well for the past several months. As a are some results I had last year
Hi, I'm a 31 y.o. F. and have been dealing with what seems to be a medical mystery that doctors haven’t been able to figure out. Long story, but here is some history:
Heart issues since age 24. Have high resting heart rate of over 100. Experiencing series of skipped beats. Had holter monitor at 24 and stress test. Recently did another holter monitor, ave. heartrate over 24 hours was 98. Found PVCs on the recording. Otherwise normal rhythm, just fast. Did ulrasound of heart, normal. Now heart symptoms at worst. Just standing makes heart go up 20-35 beats. Walk up stairs goes up to 140-150. Was an athlete as a teenager, so this is not how I used to be. These symptoms are all worse if I drink alcohol. Now can’t tolerate alcohol, I used to be able to. Age 24 noticed I peed too frequently, saw urologist. Can’t remember what came of it. Had a bladder infection in the past. Did ultrasound of bladder, came back normal. Sleeping problems as long as I can remember, still to this day. Have trouble falling asleep and don’t feel rested. Saw neurologist for suspected POTS. Did tilt table test and sweat and blood pressure test. Had positive tilt table test (i.e. heart rate went up 30-40 beats from
failure. Recently did ambulatory blood pressure test,normal. Recently did 24 hour urine test. Normal results for catecholamines. However had high urine creatinine levels (don’t have exact levels). Recently did some blood work. Results came back as high random cortisol (581 nmol/L), high aldosterone (1017 pmol/L). Renin was normal (1.10 ng/L/S). Everything else was normal (blood creatinine, glucose,B12, iron, sodium (140) potassium (3.8), ALT,sTSH,T4 free, Free T3, Hemoglobin, Hematocrit,RBC, RDW, WBC.

Any ideas on what could be going on? This is really affecting my life. I’m seeing an internist and he wants to put me on Atenolol. I’d really like to get to the bottom of this, not sure where to turn to next?
I've been experiencing pain in my upper right abdominal area, as well as a lot of tenderness in my ribs on the right side of my body. They are tender to the touch. I often feel pressure
and pain under my right ribs . I have also been experiencing stiffness around my spine in the middle of my back. It is a pulling sensation, like a pressure. It is getting uncomfortable to sleep at night. When I lie on my back it feels as if I'm lying on a marble or rock! It feels like something is in my spine. That's the best way I can describe it! I've experienced neck pain and stiffness in my neck for years, but have never experienced any problems in my back before! I went to my doctor and she ordered several tests. In her office my urine tested positive for protein. It tested positive for protein again 2 weeks later. My urine tested neg. for everything else and was sent for a bacterial culture and it came back negative. I did an ultrasound of my ovaries and uterus and they came back normal. I got an abdominal ultrasound and it came back with an area of hypodensity in the left lobe of my liver and it was 3 cm wide. They said that they could not determine what it was in the ultrasound. There were no other abnormal findings on my ultrasound. Kidneys were normal, as was gallbladder. I had blood tests done and the only abnormal finding was an ESR of 30 and my doctor said it was an indication of inflammation. Results from the blood test found that my liver and kidney function were normal. I'm scared of what all this!

I'm very worried about this spinal lesion. Here is what the report says:

"There is a lesion within the right posterolateral aspect of one of the lower thoracic vertebral bodies. This may be within the T11 body. It measures approximately 1.8 cm in maximum dimension. This does demonstrate enhancement on the post-gadolinium enhanced images. It is quite subtle on the T1-weighted images but faintly hypointense. There is relative less drop in the signal intensity on the out of phase images relative to in phase images of this lesion. However, this lesion is nonspecific and could be further characterized with a CT scan examination. A bone scan could also be considered in follow-up."

Please, what does this mean?? My doctor doesn't know. She said it may be a this consistent with a hemangioma ? Could this possibly be cancer?? Help!

Posted Wed, 2 May 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 3 hours later
Thanks for posting your query. I appreciate the effort made at providing such a detailed description.
From the description of the details given to me, it looks like you have vertebral body hemangioma. The characteristics of the lesion as seen on your magnetic resonance imaging scan (MRI scan) do not correlate with that of a malignant lesion. A computerised tomography scan (CT scan) and a bone scan can be done to confirm the same but these investigations are optional.
Otherwise, your symptoms of tachycardia fit into the diagnosis of growth and see gradual improvement into their mid-twenties. Except for the elevated random cortisol and aldosterone levels, the other tests that have been done for POTS are negative.
Beta blockers like Atenolol can control the sympathetic overactivity seen in POTS. Most patients with POTS will see an improvement in their symptoms over the course of several years, particularly those who develop in their early to mid teens. Most respond to life style changes, in particular drinking extra water and avoiding trigger situations such as standing still or getting hot.

The following dietary changes will prove to be beneficial:

1. Drinking at least 64 ounces (two liters) of water each day.
2. Avoiding alcohol. It exacerbates the symptoms of POTS as it causes vasodilation and dehydration.
3. Eating frequent, small meals and increasing salt intake is beneficial
4. Eating foods with lower carbohydrate levels
5. Caffeine helps some POTS patients due to its stimulant effects
6. Tilting of the head of the bed to an angle of roughly 30 degrees can also help reduce symptoms.
7. Regular muscle strengthening exercises

So I personally feel that you have only a hemangioma (on MRI) which was found incidentally during the evaluation for POTS. I would like to reassure you that no signs of malignancy are currently noted.
Life style changes, dietary habits and medications like Atenolol with benefit you.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.


Dr Shiva Kumar R
Neurologist & Epileptologist
Above answer was peer-reviewed by
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