DEAR DR. ROACH: I am a 64-year-old man who had an ultrasound six months ago that revealed a 1.9-cm echogenic nodule in the right lobe of my liver. The radiologist felt it was a hemangioma. I recently had another ultrasound to determine if the nodule had changed, and thankfully, it has remained the same. A separate radiologist reviewing the current ultrasound also noticed two subcentimeter hepatic cysts on the right lobe of my liver.
So, I have two questions: Are the cysts a reason for concern? And why do radiologists often differ in their interpretations of viewings? This has happened before, where one radiologist didn’t report an issue that another radiologist did in a subsequent report of the same part of the body. — M.S.
ANSWER: A hemangioma is a benign tumor of blood vessels that are commonly found in the liver. Women are more likely than men to have them, and they are most often diagnosed between the ages of 30 to 50. As many as 20% of people will have them, if you look carefully enough.
When a person gets an ultrasound for some other reason, it is common to find unexpected abnormalities (these sometime go by the name of “incidentalomas”), and the ordering physician must decide whether the abnormality needs to be evaluated. It’s occasionally the case that a person gets saved from a terrible outcome when cancer is found this way and removed before it could spread.
It is much more likely, however, that the person would have lived their entire life never knowing that they had this incidental abnormality. The vast majority of them do not need further evaluation, although sometimes a follow-up scan is ordered in the next six to 12 months to make sure the lesion is not growing like cancer would.
A hemangioma is an example of a solid mass. A fluid-filled mass (a cyst, by definition, is fluid-filled) in the liver is rarely a cause for concern. In a person with no symptoms in whom the cyst was found incidentally, no further evaluation is recommended for small cysts (less than 4 cm). These are also common — I have read estimates that 2.5% to 40% of people will have them.
It’s useful to go back and look at the first ultrasound to see whether the two small cysts found on the second ultrasound were originally there. They may have grown enough to be noticeable now, or the ultrasound may have been done in such a way that made it easier for the radiologist to notice it.
DEAR DR. ROACH: Can you please discuss testosterone pellet treatment? So many men have low amounts of testosterone. My doctor recommended a plan of Testopel pellets every few months. What are the benefits and concerns? — A.C.
ANSWER: Low testosterone levels are common in men, and replacement therapy is indicated in men with symptoms of low testosterone and repeatedly abnormally low levels, with tests done in the early morning when levels are normally the highest.
There are many different ways to use testosterone — injections being the oldest and most time-tested. Gel preparations are very convenient, but my experience is that it’s hard to get to a therapeutic level for many men. A new oral formulation is available in Canada, and a nasal gel (used three times daily) has newly become available as well. I haven’t yet had experience with either of these.
The pellets (two to six are typically used) are placed surgically under a local anesthetic every three to six months. Potential side effects include infection, fibrosis and extrusion of the pellets. I believe this has limited use.
* * *
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
(c) 2023 North America Syndicate Inc.
All Rights Reserved

Copy the Story Link

« Previous

How to treat lymphedema, aka the swelling of the lymphatics

Next »

Screening men for osteoporosis remains controversial