Hi doctor, My father is 56 years old. He is a diabetic patient. He has a frequent low-grade fever associated with pain in the right side of the front abdomen starting just below the lungs. He also had significant weight loss in the past two months. He has also developed a breathing issue suddenly while talking and gets tired easily after performing minimal tasks. He was recently admitted in a hospital where he underwent all the necessary tests and the USG of the whole abdomen which reported a SOL of size 42 × 35 mm in the right upper lobe of the liver and no other complexities. Further, he has taken a CECT scan where the report came as mild pleural thickening and minimal effusion seen on the right posterior costal wall of lower thorax and a SOL of size 10 × 9 × 11 cm which is hypodense in nature having a rim and a centripetal enhancement seen in right lobe of liver devoid of calcification or cystic or necrotic degeneration in the right lobe and the radiologist commented as the nature of the SOL suggestive of hemangioma. He has undergone an AFP (alpha-fetoprotein) test which gave a reading of 1.28 ng/mL. Also, he had a serum ferritin reading of 864.5 ng/mL. He has also undergone colonoscopy due to occult blood in stool and was found alright. He is discharged from the hospital with some medication. Please guide me with the further procedures as he is still facing issues with his health.
Hi. Sorry to hear about your father's symptoms. I have checked the attached photos thoroughly (attachment removed to protect patient identity). I agree that his symptoms are due to SOL (space occupying lesion) in the liver which is most likely a hemangioma. I will reassure you that the lesion is not malignant. However, a ruptured hemangioma is a severe condition. Most of the cases, there is conservative therapy for treating the symptoms. It is followed by repeating the ultrasound after one month, three months and then every six months to identify any increase in size. Usually, lesions less than 6 cm are treated conservatively. Surgery is the treatment for the lesions more than 6 cm, rapidly growing lesion, ruptured hemangioma or severe uncontrolled symptoms. I recommend Paracetamol for the pain and fever. Please send me the CBC (complete blood count) report to exclude the ongoing infection.