Seeking Clarity on MRI Findings
Greetings! I'm a 26-year-old female in generally good health, but I've been experiencing raised ALT levels for a year and a half. Due to this and several inconclusive lab results, my physician recommended an abdominal ultrasound. This imaging test indicated a liver that appeared normal and healthy apart from a small calcification. Additionally, a 10 mm cyst was detected in my spleen. Following this, my doctor advised that I undergo an abdominal MRI to further examine the cyst. I recently received the MRI results and find myself somewhat perplexed and in need of clarification. The findings state: "1. Multiple serpentine high-signal regions along the upper and mid surface of the spleen. 2. While this may indicate a splenic AVM, a multi-phase CT scan is suggested for verification." Overall, I maintain good health, exhibit no particular symptoms, and most blood tests are normal, with the exception of a slightly elevated ANA. I would appreciate any insights you may have!
Answers (1)
3/19/2025, 4:40:43 PM
OpenHealth AI
Thank you for sharing your MRI findings and the context behind them. Here’s a breakdown of your results, what they mean, and the next steps you might consider.
Main Points:
- Your MRI indicates potential vascular changes in the spleen.
- A multi-phase CT scan is recommended for further evaluation to confirm the nature of these findings.
Explanation:
- Serpentine High-Signal Regions: The MRI shows multiple areas in your spleen that appear differently than surrounding tissues. In medical imaging, this can suggest abnormal blood vessels (in this case, possibly an Arteriovenous Malformation, or AVM), which is an abnormal connection between arteries and veins.
- Importance of CT Scan: The recommendation for a multi-phase CT scan is because it provides more detailed images and can better differentiate between types of tissues and vascular structures. This will help clarify whether these changes are indeed an AVM or something else.
Next Steps:
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Schedule the Recommended CT Scan: Prioritize getting the multi-phase CT scan as recommended by your doctor. This is a crucial next step to get clarity on the MRI findings.
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Monitor Your Health: Continue to observe any changes in your health. If you notice any new symptoms such as pain, swelling, or changes in appetite, be sure to note those.
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Follow-Up Consultation: Once you have the results of the CT scan, consider discussing them thoroughly with your physician. They will be able to explain the findings in detail and discuss any necessary treatment or monitoring options based on the results.
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Stay Informed: While waiting for the CT scan and results, it may be helpful to educate yourself about splenic conditions and vascular abnormalities. Understanding your health will help you feel more empowered and prepared to discuss your situation with your doctor.
Remember, staying proactive and informed is crucial, and you are doing the right thing by seeking clarity on your health! If you have any more questions or need further explanation, don't hesitate to reach out.
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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.