I have been sick since May 21, 2018. I now have the results of both the MRI and Cat scan. Now, I have to figure out what to ask the Dr or Dr's. The set up an Endoscope for Oct, 19. 2017. The colonoscopy from 9-5, 2017 did not go in far enough to see anything. I am posting this here for now to get advice from friends what to ask.
When the Dr called she said I have a 3x3cm mass that may be cancer. And/or crohns.
MRI Abdomen
Report
MRI examination of the abdomen (MR enterography protocol)
Indications: Nausea, vomiting and diarrhea. Recent small bowel
obstruction. Evaluation of the terminal ileum for possible mass versus
stricture.
Comparison: CT 8/10/2017.
Technique: The study was performed at 3 Tesla MR scanner. Examination
included multiple MR images of the abdomen and pelvis in different
pulse sequences and different imaging planes before and after IV
contrast administration.
Findings:
The examined portions of the liver and spleen are unremarkable. No
focal lesions. The gallbladder is absent. No biliary ductal
dilatation.
The pancreas, adrenal glands and both kidneys showed no significant
abnormality. Left renal a few tiny hepatic cysts. No collecting system
dilatation.
Redemonstration of multiple dilated loops of small bowel in the
abdomen and pelvis measuring up to 4.2 cm, for example series 25 image
39. Again, there is abrupt change in caliber of the dilated small
bowel loops in the right lower quadrant at the level of the masslike
enhancing lesion measuring 2.7 x 2.8 x 2.7 cm, for example series 29
image 52 and series 25 image 50. Multiple adjacent tethered and matted
bowel loops are redemonstrated in the right lower quadrant.
A few borderline enlarged upper abdominal and right lower quadrant
mesenteric lymph nodes, likely reactive. Multiple nonenlarged
abdominopelvic and bilateral inguinal lymph nodes are also seen. No
ascites.
The urinary bladder is unremarkable. The uterus is present. Left
ovarian small functional cysts.
The imaged abdominal and pelvic vasculature is unremarkable.
Conclusion:
1. Redemonstration of multiple dilated loops of small bowel measuring
up to 4.2 cm with abrupt change in caliber in the right lower quadrant
at the level of a 2.7 x 2.8 cm masslike enhancing lesion. Findings are
likely to represent sequela of active inflammatory bowel disease. The
enhancing mass could be of inflammatory/neoplastic etiology.
2. There are multiple adjacent tethered and matted bowel loops in the
right lower quadrant, suggestive of entero-enteric fistula.
3. A few borderline enlarged upper abdominal and right quadrant lymph
nodes, likely reactive.
Cat scan
EXAM:
CT of the abdomen and pelvis with IV contrast. Coronal and sagittal
reformats.
COMPARISON:
No comparison.
FINDINGS:
There is diffuse distention of ileal small bowel loops, with a focal
transition point noted approximately 12 cm from the ileocecal junction
(series 2 image 98). The ileum proximal to this transition point is
dilated up to 4.3 cm and is edematous. Ileum distal to this transition
point is decompressed. There is no significant inflammation of the
mesentery. No abdominal free fluid or free air.
The lung bases are clear. The liver, cholecystectomy changes, spleen,
and pancreas are normal appearing. There is a 1.2 cm right adrenal
nodule. The left adrenal is unremarkable.
The kidneys, ureters, bladder, and uterus/adnexa are normal appearing.
Multiple phleboliths in pelvis.
The major vascular structures are intact. No significant
atherosclerosis. No acute osseous findings.
IMPRESSION:
1. Findings suggestive of partial small bowel obstruction, with
transition point noted approximately 12 cm proximal to the ileocecal
junction.
2. Indeterminant right adrenal lesion (no comparison exams available).
Recommend nonemergent CT adrenal protocol to further delineate.
These findings were communicated with Dr. McCray at 2337 today.
Attending addendum:
1. There are multiple dilated small bowel loops in the abdomen and
pelvis measuring up to 4 cm. Some of the dilated bowel loops show
diffuse wall thickening and mucosal hyperenhancement. Small bowel
fecal sign is seen in the right lower quadrant, series 2 images
110-103. Adjacent to this level there is abrupt change in caliber of
the dilated bowel loops with associated masslike density, for example
series 2 images 101-96. Tethering of the adjacent bowel loops is also
seen.
Adjacent a few borderline enlarged mesenteric lymph nodes. Wall
thickening and mucosal hyperenhancement of the decompressed ileocecal
junction and terminal ileal loops with similar changes in the right
side of the colon.
2. Findings are concerning for inflammatory bowel disease with tight
inflammatory stricture in the right lower quadrant. Associated
entero-enteric fistula or underlying mass cannot be entirely excluded.
Clinical correlation, continued attention in follow-up studies and/or
further assessment by MRI enterography is suggested.
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