Can you solve this medical mystery? I had a ct

Patient

Q: Can you solve this medical mystery? I had a ct of the abdomen and the radiologist found diffuse hyperattenuation of the liver as in hemochromotosis or amiadarone administration. I had blood work done and the iron tests were normal or low. I have never had amiadarone. A gastroenterologist said it was fat in the liver; I don't think so. What is in my liver? What should I do?

Symptoms:  Loss of body hair, fatigue, swelling in legs,ankles, and feet, nausea and stomach pain when hungry, tan skin, arthritis, osteoporosis, hypothyroidism...too many to name but some may be from hypothyroidism
Doctor

A:   Hi.
Welcome to Ask the Doctor. Thanks for your query.

I have gone through your question in detail and understand your concerns.
Please find my observation below:

> Hepatic attenuation is seen in many conditions namely
- Hemochromatosis.
- Wilson's disease.
- Glycogen storage disorders.
- Medications like amiodarone, gold therapy.
- Hepatocellular carcinoma.
- Liver cirrhosis.

> I have seen your list of symptoms and if I were your treating Doctor then, I would have recommended you to got for MRI upper abdomen and Liver biopsy to rule out liver cirrhosis and Hepatocellular carcinoma.

> This is not to fear you, but we will get a clear idea regarding hepatic attenuation. If there is a cause then we can start medications for it at the appropriate time.

> Swelling in legs, ankles and feet, loss of body hair, fatigue, nausea, pain in the abdomen, arthritis, skin changes may also be seen in hepatic dysfunction.

> For this reason, I suggest you have to get Liver function test, MRI upper abdomen and Liver biopsy to rule out any liver pathology and come to an appropriate diagnosis.

> Please go ahead with the above-mentioned tests and you can follow up with the reports.

Hope I have answered your question in detail.

Wish you good health.
Take care.

Comments / Follow Ups

Patient: the ct was done without contrast and no masses were seen: liver functions were normal; I will ask my doctor for the other things altho he does not take me seriously. Thank you for your detailed answer and if you have more info or advice I hope you will share it.
Doctor: Hi.
You are always welcome.
Thank you for writing back with an update.

- In early stages of liver cirrhosis, it is very difficult to diagnose by CT, as nodules are not seen in initial stages. Whereas in diffuse pattern of HCC also there will no nodules/masses seen in CT.
- I am not sure if you are having this, but to just rule out these two differential diagnosis, I recommend you to go for MRI upper abdomen and latest Liver function test.
- Also if there is liver metastasis then we can see hepatic attenuation. This means the primary focus of malignancy is somewhere hidden and its presence is manifested by the detection of metastatic nodules.
- I sincerely request you to get a thorough examination of your body so that we can see for any underlying pathology which is causing all these symptoms.
- If everything comes normal, then you can be rest assured and think that you have those symptoms because of your comorbidities.

Hope this helps.

Good luck.
Patient: I have had the ultrasound and they said everything was normal! Can the density of the liver change? Can that symptom just go away? was ultrasound the right test to have? Who should i believe?
Patient: they would not do an mri.
Doctor: Hi.

Well, ultrasound of the abdomen was not necessary as such.
However as you did it, and the reports were normal, that's great. I also advised you to get some other tests like Latest Liver function test and Liver biopsy, if you have done it please attach a copy of it for my reference.
Ultrasound was not advised by me.

Let me inform you that, there are chances that liver may regain its original density after some time like 8-12 weeks, provided you do follow certain good lifestyle modifications like, eating a healthy diet, not using analgesics and antibiotics frequently on your own, stop drinking alcohol, do physical exercise daily.

You can wait and watch for some time to see if the symptoms are getting better or else please consult a good Gastroenterologist near you, so that he can physically examine you and do the needful.

Hope you understand this.

I have already answered your 2 follow up questions by now.
In case if you have any further queries, please post a new question.

Wish you good health.
God bless.

Regards.

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