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Dr. Andrew Rynne

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What causes pain in upper right quadrant?

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Dr. Deepika Patil

General Surgeon

Practicing since :2008

Answered : 745 Questions

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Posted on Thu, 21 Aug 2014 in Liver and Gall Bladder
Question: 56 year old female. I was having some mild to moderate pain in upper right quad. Had a CT scan in late March, 2014: family doctor's secretary called me and said I have a "fatty liver," that the doc says it is common, and he is not worried about it. I received no response on my repeated inquiries about the pain. Today, 4 months later, I secured the orignal report from the radiologist: CT scan shows subcentimeter septated cyst. And hepatic steatosis. No cholestasis. Recommended MR___ (can't remember full name) for further assessment. My family doctor never reported the cyst to me, nor the recommended further testing. I have an appointment in a few weeks with a new doctor, an internist. In the meantime, can you please tell me what is a septated cyst? Thank you very much.
doctor
Answered by Dr. Deepika Patil 2 hours later
Brief Answer:
see below

Detailed Answer:
Hi,

Welcome again to HealthcareMagic.

A septate cyst is a fluid filled spherical swelling with internal partitions. They are usually benign in nature.

Due to their size and location they may cause symptoms like pain and jaundice (unlikely in case of subcentimeter cyst, as they are too small for it). Maybe considering the size, your doctor decided to ignore it.

Hope I have been helpful.

Regards,
Dr.Deepika Patil
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Deepika Patil 6 hours later
Thank you very much, Dr. XXXXXXX My main concern is that I have soreness or mild pain there, maybe 3-4 days out of every 7 days. When I go swimming (twice a week), there is so pain there for at least 24 hours.

Thank you, XXXXXXX
doctor
Answered by Dr. Deepika Patil 4 hours later
Brief Answer:
could be muscle sprain

Detailed Answer:
Hi,

Pain which increases after an muscular activity is more likely to be a muscular sprain.

Also your CT scan is almost normal, apart from the liver conditions, which will not cause you this type of pain.

So I would suggest that you take some muscle relaxant and refrain for activities that aggrevates the pain for 4-6 weeks to allow the injured muscle to heal completely.

Regards,
Dr. Deepika Patil
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Deepika Patil 1 hour later
Thank you, doctor. I am sorry - that was a typo - I meant to say there is NO pain after swimming, for about 24 hours. In other words, exercise seems to relieve the pain in that area. Here is my full radiology report, that may help:


ULTRASOUND OF RIGHT UPPER QUADRANT 03/28/14
Ultrasound of right upper quadrant is performed. The pancreas is
normally visualized. The liver is of normal size. The echogenicity
of the hepatic parenchyma is increased due to fatty metamorphosis.
There is a 6 x 6 x 7 mm cyst within left hepatic lobe containing thin
septation.

No cholelithiasis is seen. The gallbladder wall is normal in
thickness. There is, however, a comet-tail artifact emanating from
the gallbladder wall, indicative of focal adenomyomatosis of the
gallbladder wall. The common duct is mildly dilated, measuring up to
7 to 8 mm in size with no intrahepatic biliary ductal dilatation observed.

Cursory evaluation of right kidney shows no abnormality.

IMPRESSION:
There is a subcentimeter septated cyst within left hepatic lobe with
hepatic steatosis.

Focal adenomyomatosis of the gallbladder wall with no cholelithiasis
or evidence of cholecystitis. The common duct is dilated at 7 to 8
mm with no choledocholithiasis seen. No intrahepatic biliary ductal
dilatation is observed. Perhaps MRCP could be considered as a means
of further assessment.

Normal appearance of pancreas.
doctor
Answered by Dr. Deepika Patil 7 hours later
Brief Answer:
needs further investigation

Detailed Answer:
Hi,

As per your usg report, your common bile duct (CBD) is a little more dilated. And usg cannot 100% rule out CBD stone as the last portion of it is below the bowels, through which it can see.

Also this report is 4 months old. So I would suggest that you get a repeat scan to see if it has increased or reduced in size or go for an MRCP. Also get your liver profile test done. If it was done last time, get it repeated, to identify any changes.

Discuss these with your physician and revert back to me with the new scan.

Regards,
Dr.Deepika Patil
Above answer was peer-reviewed by : Dr. Yogesh D
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