Totally confused/US

[JR0102]

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This ultrasound is over my head. 31 y/o homosexual asian-american male presents w/ left flank pain only, UA neg, Hep B/C serology neg, HIV neg, we ordered an ultrasound of abdomen, and KUB. Kidneys and UT were normal, but liver showed diffuse fatty infiltration, focal sparing @gallbladder, and focal nodular parenchymal changes in right lobe. Biliary tract neg. Pt has history of 6+ years of heavy etOH, and one suicide attempt w/ APAP but was not hospitalized, no meds, no IVDU. Now WTF do I work him up for. I thought focal nodular hyperplasia was a benign condition mainly in women. Is this cirrhosis? Could the FNH changes be left over scarring from the APAP OD? What does this mean?

 

[JR0102]

No one has any suggestions.

 

[Docxter]

This ultrasound is over my head. 31 y/o homosexual asian-american male presents w/ left flank pain only, UA neg, Hep B/C serology neg, HIV neg, we ordered an ultrasound of abdomen, and KUB. Kidneys and UT were normal, but liver showed diffuse fatty infiltration, focal sparing @gallbladder, and focal nodular parenchymal changes in right lobe. Biliary tract neg. Pt has history of 6+ years of heavy etOH, and one suicide attempt w/ APAP but was not hospitalized, no meds, no IVDU. Now WTF do I work him up for. I thought focal nodular hyperplasia was a benign condition mainly in women. Is this cirrhosis? Could the FNH changes be left over scarring from the APAP OD? What does this mean?

Focal nodular parenchymal changes is an US finding and you shouldn't confuse it with the disease entity, focal nodular hyperplasia (FNH). While it could be due to FNH, you must think of other differentials for this finding, including cirrhotic changes, lymphoma, mets, sarcoidosis, etc. What are the LFTs? Was there anything on the ultrasound (i.e., lesion characteristics) that would favor one over the other?