INCIDENTAL FINDINGS

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INCIDENTAL FINDINGS

• Joel Thompson, MSIII
• November 19, 2008

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History

• 36 yo M (158 kg) presents to the ED c/o BL renal
  colic, RgtL
• CBC, BMP, LFTs, lipase, alb, protein, UA all
  unremarkable except
• Glucose 366
• Alk Phos 160 (normal 38-126)
• Glucosuria and trace ketonuria
• CT A/P stone protocol was performed

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(No Transcript)
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1.87 cm
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26 cm
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17.6 cm
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Results

• Possible lt1mm stone in proximal left ureter
• Hepatomegaly (C-C 26 cm, nml lt 16 cm)1
• Splenomegaly (C-C 17.6 cm, nml lt 13 cm)2
• Nodular contour of liver
• Hypertrophied left lateral and caudate lobes
• Recanalization of the umbilical vein
• Mild dilation of portal vein (1.8 cm)
• ALL FINDINGS SUGGESTIVE OF

1. Akbar, DH and AH Kawther. Nonalcoholic Fatty
Liver Disease in Saudi Type 2 Diabetic Subjects
Attending a Medical Outpatient Clinic. Diabetes
Care 263351-3352, 2003.
2. McClain, KL and SA Landow. Approach to the
child with an enlarged spleen. Uptodate.com.
Accessed November 18, 2008.
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CIRRHOSIS!!! (with related portal hypertension)

• Cirrhosis is late state of hepatic fibrosislate
  cirrhosis is generally irreversible
• Distorted hepatic architecture and regenerative
  nodules
• Can be caused by a litany of diseases, including
• Alcoholic liver disease, Hep B/C, NASH (?), PBC,
  PSC, autoimmune hepatitis, hemochromatosis,
  Wilsons disease, alpha-1-antitrypsin deficiency,
  cardiac cirrhosis
• Physical findings include
• Spider angiomata, gynecomastia, palmar erythema,
  nail changes, clubbing/HPOA, Dupuytrens
  contracture, HSM, testicular atrophy, ascites,
  caput medusae, jaundice, fetor hepaticus,
  asterixis
• Can lead to HCC

Goldberg, E and S Chopra. Diagnostic approach
to the patient with cirrhosis. Uptodate.com.
Accessed November 19, 2008.
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Role of Radiology

• Cirrhosis is a pathologic diagnosis, so radiology
  can only suggest the diagnosis
• Can evaluate for complications of cirrhosis (e.g.
  ascites, HCC, hepatic/portal vein thrombosis,
  etc.) and, rarely, can reveal etiology of
  cirrhosis
• Ultrasound is routinely used in evaluationcan be
  used as screening tool for HCC and portal
  hypertension
• Stiffness measurementincreased liver scarring
  causes increased liver stiffnessa newer
  ultrasound device is used to evaluate
• Very helpful with advanced fibrosis
• Little role or unclear role for CT/MRIMRI may be
  helpful in determining Child-Pugh score, but use
  is still limited

Goldberg, E and S Chopra. Diagnostic approach
to the patient with cirrhosis. Uptodate.com.
Accessed November 19, 2008.