Understanding CT Findings After ER Visit
Hello! I’m a 32-year-old woman, weighing 190 pounds and standing at 5’3”, with a history of hypothyroidism. Recently, I sought emergency care due to persistent vomiting and was diagnosed with arthritis, which the doctors suggested might stem from a viral infection or food-related issues. During my visit, they performed an abdominal CT scan because my white blood cell count was notably elevated, and the results included several incidental findings that I would like to discuss. The attending physician did not address these findings, so after reviewing the report, I have concerns regarding my bladder, kidneys, and peritoneum. I would appreciate any insights regarding these findings! **Liver and Biliary System:** There are no detected lesions on the liver, and both the portal and hepatic veins are clear. It’s noted that my gallbladder is surgically absent, and there is no dilation of the biliary ducts. **Spleen:** The spleen shows no signs of enlargement. **Pancreas:** There are no detectable masses or issues with the pancreatic ducts. **Adrenal Glands:** No nodules were found in the adrenal glands. **Kidneys/Ureters:** The report indicates no hydronephrosis or stones present, nor are there any solid masses. Small hypodense areas in the right kidney are noted, likely cysts, but they are too small to be identified clearly. **Gastrointestinal Tract:** A small hiatal hernia is present, but there are no signs of distention or wall thickening. The appendix appears normal, and there are several areas of air and fluid filling the small bowel, which are of normal caliber. **Peritoneum/Retroperitoneum:** There is a slight amount of fluid in the cul-de-sac, which is likely normal, without any free air detected. **Lymph Nodes:** There is no indication of lymphadenopathy. However, numerous small lymph nodes can be observed in the mesentery and retroperitoneum; they do not meet the criteria for being classified as lymphadenopathic. **Blood Vessels:** Appearing normal and unremarkable. **Pelvic Organs/Bladder:** The uterus is positioned anteverted, and there's a cyst on the left ovary with a scalloped, hyperemic wall, likely indicative of a corpus luteum cyst. The urinary bladder is stated as mildly distended but appears otherwise normal. **Bones and Soft Tissues:** There is mild degeneration observed across several intervertebral discs, primarily at the L4-L5 and L5-S1 levels. No recent fractures, and there are no masses or collections identified in the subcutaneous or intramuscular tissues.
Answers (1)
3/26/2025, 7:30:50 PM
OpenHealth AI
Thank you for sharing your CT findings and health concerns. I understand that you are seeking clarity on the incidental findings related to your bladder, kidneys, and peritoneum after your emergency visit. Here’s a summary of the key points from your CT results, along with explanations and actionable steps.
Summary of Key Points:
- Kidneys: Small cysts noted in the right kidney, but no stones or mass.
- Bladder: Mildly distended but otherwise normal.
- Peritoneum: Minor fluid in the cul-de-sac is likely normal; no free air is present.
Explanation:
- Kidneys: The small hypodense areas (likely cysts) in your right kidney are common and usually benign. They are typically not a cause for concern unless accompanied by additional symptoms.
- Bladder: A mildly distended bladder may suggest you were unable to fully empty it, possibly due to a recent episode of vomiting or fluid intake. If there are no symptoms (like pain or frequent urination), this finding is often not significant.
- Peritoneum: A small amount of fluid in the cul-de-sac (the space within the pelvis) can be normal and is often not indicative of any underlying issue, especially if there's no free air, which could suggest a more serious condition.
Next Steps:
- Monitor Symptoms: Keep an eye on any new symptoms you might experience, such as pain in the abdomen, changes in urination, or persistent gastrointestinal upset.
- Hydration: Ensure you are staying hydrated, especially if you have been experiencing vomiting. Drinking clear fluids can help prevent further complications.
- Follow-Up: Consider scheduling an appointment with your healthcare provider to discuss the findings in more detail, particularly the cyst and any symptoms related to your urinary system or abdominal discomfort. They may recommend follow-up imaging or tests depending on your health history and current symptoms.
- Keep a Health Diary: Document any changes in your health, including the frequency of your symptoms and any potential triggers. This can provide useful information for your healthcare provider during follow-up.
If you have specific concerns about the findings or if new symptoms develop, don’t hesitate to reach out for more personalized advice. Take care!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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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.