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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does the following MRI scan report indicate?

Answered by
Dr.
Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6688 Questions

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Posted on Mon, 17 Jul 2017 in X-ray, Lab tests and Scans
Question: hi

I want my question to be answered by a radiologist who can read and review my mri scan files and provide me diagnosis for my problem. sir Pls provide me the link where I can upload Dicom files for mri scan

thanks
doctor
Answered by Dr. Vivek Chail 30 minutes later
Brief Answer:
Please upload to dropbox or google drive

Detailed Answer:
Hi,
Thanks for writing in.

It will be nice if you can upload the complete contents of your CD or DVD containing MRI images to a file upload facility like dropbox or google drive from which I can download and view the images on my work station.

My email id is YYYY@YYYY

Please share and send me a link in mail.

Please send details of your condition and symptoms.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 45 hours later
Thank u sir

I m attaching the link in ur mail in the name of XXXXXXX XXXXXXX .
Presently I m having swelling in lower abdomen particularly on left side with sitting difficulty as well as back pain.. History of lscs ..Nov 14..post this I had continuous ongoing problem in lower abdomen. Pls guide


doctor
Answered by Dr. Vivek Chail 12 hours later
Brief Answer:
Multiple causes of back pain need to be analysed

Detailed Answer:
Hi,
Thanks for writing back with an update.

I have viewed your MRI scan images which you shared using the link.

The following findings are visualised in the scan.
1. There is bilateral sacro ilitis (inflammation of the lower back). This is found to be more on the right side.
2. There is some suspicious fat stranding in the left lower anterior abdominal wall. This is not a well defined lesion and not any tumour or abscess. This can be related to the findings mentioned in the high frequency ultrasound scan report which you have attached.
3. There is a small artefact area seen only on few images on the left side of anterior abdominal wall. This I feel is not clinically significant.

Other findings include mild disc degenerative changes in L4-L5 disc level with a likely mild disc bulge.

Now coming to your symptoms, I acknowledge that most of it started following your LSCS. However other than above findings in the left anterior abdominal wall, there is nothing much contributory. At the same time any surgery including LSCS can have associated mild complications which can be painful and give discomfort for a long time.

Sometimes there can be more than one cause for pains, especially involving the lower back. If you were my patient then I will suggest a lumbosacral MRI scan for you to know if there is any multi level disc problems which is contributing to your pain in the back.

Regards,
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Vivek Chail 14 hours later
thank u so much for the detailed reply doctor.. highly appreciated!!

sir are these all things pointing towards tuberculosis or can Tb or cellulitis present picture like this??

what can be the reasons for this fat stranding since I can recall the same wen my first mri was done in XXXXXXX 15..that also presented the same but was on right side of abdominal wall where my lscs stich was done.. (enclosing that report also)).. what could be the possible reasons for this.. even if this is inflammation wat is to be done. sir since it is all increasing with passing time( lscs Nov 14) and so is my discomfort


can fat necrosis be removed from surgery?? should I consult a surgeon gynae or rhematologist..

back pain doesn't bother that much as compared to abdominal problem what to do for this

will CT scan show a better picture rather than mri for the problem


Pls guide doctor
doctor
Answered by Dr. Vivek Chail 19 hours later
Brief Answer:
Discussing with general surgeon might help

Detailed Answer:
Hi,
Thanks for writing back with an update.

TB is a chronic infection and can affect any part of the body, but TB usually spreads if not treated. If you are taking treatment and there is no increase in disease area then it is less likely to be TB infection.

Cellulitis is infection due to bacteria. This has acute infection symptoms and therefore you do not have it now. If it was acute symptoms and short duration then I will think of cellulitis.

Fat necrosis is a general term applied to inflammation of the fat tissue. This can be acute or show chronic symptoms. Surgery helps only if there is a well defined disease area which is the focus of such abnormality.

You do not have any specific gynecological symptoms show going to a gynecologist might not be of much help.

The rheumatologist might help to assess your low back ache and sacro ilitis. However you mentioned that the low back ache is not a big trouble.

Keeping the above in mind, consulting general surgeon might help. Suspected fat necrosis of anterior abdominal wall is an area of interest for the general surgeon.

It is difficult to say the amount of abnormality which a CT scan will show but you can take a chance because normal fat is clear and fat necrosis might show haziness and stranding. However it is clear the MRI scan is not showing any acute inflammation and edema.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 2 days later
thank u so much for ur detailed reply

Yesterday I consulted a rhematologist ..she wanted to go for some blood tests like c3 c4 and serum ace etc. And want to rule out the possibility of panniculits and it's reasons for auto immune cause.. She also wanted to get a punch biopsy done for affected area.. Is that safe doctor if at any case it is Tb or cancer as I have been told that biopsy may further aggravate the problematic area by spread by one of the radiologist once..does that happen sir


Can this fat stranding be because of cancer or suture granuloma formation...

Is my case really a rare case doc.. Is panniculits a rare disease with no solution..

Why is this scarring keeps increasing in my subcutaneous fat despite taking att
doctor
Answered by Dr. Vivek Chail 13 hours later
Brief Answer:
Punch biopsy is a safe procedure

Detailed Answer:
Hi,
Thanks for writing back with an update.

It is good to do detailed tests fomentr auto immune conditions. A punch biopsy is safe and will not cause any significant side effects.

Cancer is a condition which progresses rapidly and it is unlikely that you have cancer. TB is less likely because you have otherwise been in good health and taken treatmient for it.

Spread of any active infection is a higher possibility but you do not have such conditions.

The fat stranding can be due to granulation tissue but unlikely from cancer in my opinion.

Panniculitis is uncommon and in acute phase it can be treated with antibiotics. This condition shows a wide spectrum and any one treatment cannot be given to every patient.

It might not be TB in the first place and that is why a punch biopsy can help to confirm diagnosis.

Regards,
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Vivek Chail 2 days later
Thanks doc

Sir u mentioned that there is some suspicious fat stranding in left side of Abdominal wall.. What can that be..

is there any treatment for fat necrosis

Can I get some blood tests to rule out cancer
doctor
Answered by Dr. Vivek Chail 7 hours later
Brief Answer:
Treatment is better in cases of focal fat necrosis

Detailed Answer:
Hi,
Thanks for writing back with an update.

There is normal fat under the skin. Due to irritation of the fat cells, it can develop inflammation and this can become fat necrosis due to transformation of the fat tissue.

Fat necrosis can be of many types and it is not the same in every patient. It can range from antibiotics to small surgery.

Treatment of fat necrosis is more clear where there is focal fat necrosis. In case of an ill defined or diffuse fat necrosis, the treatment is difficult.

There are no blood tests to rule out cancer of the abdominal wall.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 23 hours later
thank u so much sir

I m sorry to ask but as far as my ultrasound report is concerned that is showing Ill defined areas of fat necrosis is my treatment possible or not??? does this problem have any line of treatment ?? ireside in XXXXXXX if u can Pls tell me where to go
doctor
Answered by Dr. Vivek Chail 11 hours later
Brief Answer:
Treatment to be directed after confirming diagnosis

Detailed Answer:
Hi,
Thanks for writing back with an update.

The situation in your case is that there is no definite focal lesion to treat and the pattern is diffuse or scattered. The ultrasound scan report is also only giving us a suggestion of fat necrosis. Whether it is there or not needs to be confirmed by a tissue biopsy.

In this way, it will be better to discuss your problem with the dermatologist and probably a plastic surgeon and since you are in New XXXXXXX there are many options to find specialist doctors in these fields.

Till now, it is usually treatment by medicines as first line of treatment and with follow up imaging, surgery can be done if there is any focal lesion.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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