Nodular Contour

[Confused2024]

Good Morning - has anyone ever had a "nodular contour" or "minimal irregularity at the subscapsular area" show up on an ultrasound and then go away? I had it show on two ultrasounds and now my most recent it does not say the nodular contour....hoping like crazy that means it has reversed that issue....anyone have experience with this to share? Thank you so much!

[MINTVCX]

"A nodular aspect of the liver surface results from the effects of fibrosis and the regenerative nodules on the capsule. This is a reliable sign of fibrosis, though it is subjective"

However it is not so specific (false positive) and subjective. In addition when it is not seen any more. Check this with your dr maybe other tests are needed to clear this or none at all.

I had "heterogeneous echotexture on ultrasound" which also could have been serious issue (severe fibrosis). But it turned out not big issue after further diagnosis.

[Belleben in reply to MINTVCX]

What was your further diagnosis

[MINTVCX in reply to Belleben]

To be honest nothing. Maybe S1 fattty liver. And Gilbert's syndrome but it is harmless for me. "heterogeneous echotexture on ultrasound" seems to have been been from local fat.

[Confused2024 in reply to MINTVCX]

I would give my left arm for that diagnosis...so sad - the Drs knew I had severe fatty liver in July 2021 and noone thought it was important to tell me or I would have corrected it immediately

[Confused2024 in reply to Belleben]

Belleben - do you mean mine? My GP is saying Cirrhosis due to the nodular contour and I had ascites once (knock wood) but it has resolved although I am on diuretics. Still waiting since June to see the hepatologist and just eating well, doing exercise and trying not to stress but that is a tricky one. My last ultrasound elastology said my liver went from 11.8 kpa in July to 9.0 kpa in October so crossing my fingers that I am able to reverse this and live a clean healthy life as I wish this for everyone!!

[Confused-one in reply to Confused2024]

Hi

So funny that our nicknames are so similar and I suspect it's because of the same situation, which is flipping confusing.

I was given a diagnosis of decompensated cirrhosis due to being jaundiced and having some ascites in July 2020. I also had a coarse echo texture in ultrasounds and scans. I was a long term heavy drinker and this all added up, to my horror. The jaundice and ascites fortunately cleared up after I went totally abstinent.

I kept on asking how bad the situation was with my consultant which he never answered. In the end after a year he sent me for a fibroscan, I suspect to shut me up. The result came back 6.9. He said it must be a false positive and seemed to be content at that. I told him he couldn't just say that without retesting and so he sent me back for another (this is a really important point about pushing in the NHS when you're not satisfied.)

Because of wait times, it was two years since the first diagnosis when I got my second fibroscan. The heptology nurse who did the original scan was lovely and a bit professionally offended by the consultant's response and so deliberately overtested me in the second scan. The result was 7.7 and although I had some fibrosis, it was far off a cirrhosis diagnosis which was finally reversed.

Best guess as to what happened to me is that severe covid in March and April so inflamed my liver that it stopped working properly for a while. However, there is no doubt in my mind that if this hadn't happened to me, I would have ended up in cirrhosis. My heavy drinking made that inevitable.

I am now abstinent as alcohol and I don't work together. It's just a truth that so many of us don't want to hear, but when you finally, finally, finally face it and accept it, it is so important and actually in the end a relief. But it took me years and this horrendous scare to accept it.

My consultant said that the books say you can't reverse fibrosis but that he has seen it happen rarely. With luck it may occasionally be possible. The most important thing is to try. Good luck.

[Confused2024 in reply to Confused-one]

That is great - did you also have a nodular contour? Like I said mine did not show on the last one so I am hoping an praying that means it has resolved...the only thing that is it shows a mild irregularity at the subscapsular area so hoping that goes too. I am trying to wrap my head around the fact that my liver shows fairly homogenous...on the HCC screening I was a "1" which I think means no nodules? I also show as no focal lesions thank goodness...I just really don;t believe I have cirrhosis...a sick liver yes...so I am doing my best!

[Confused-one in reply to Confused2024]

The clinical minima level for cirrhosis is 12.5 to 14.5 kpa last time I looked it up, so at 9 that doesn't meet the threshold. Obv discuss with your specialist. 9 is moderate scarring...

[Confused2024 in reply to Confused-one]

That is how I understand it too but the fact that I had ascites is what is making them tag it as cirrhosis

[Confused-one in reply to Confused2024]

Have you had medium to bad covid at any point? I ran a covid forum for 2 years and there is this small but significant cohort of us who had such inflammatory reactions that our livers went into *temporary* severe underperformance (on top of existing scarring) so that things like jaundice and ascites happened. This is precisely why I was also diagnosed with cirrhosis for 2 years but my consultant has now accepted after 2.5 years that the diagnosis cannot stand with the kpa reading I have and no repetition of either the ascites or jaundice since 2020.

My liver wasn't in a great state anyway (in my case drinking). My theory is that on its own the inflammation / damage from covid would not have made a person with a healthy liver go into a temporarily decompensated state. But since mine was already in a not great way, I started at a worse place and so the cumulative effect of poor starting condition and covid inflammation was enough to put me into temporary decompensated. My consultant has said this makes as much sense as anything and he can't explain it any other way.

[Grassroots112 in reply to Confused-one]

Amazing turnaround and congrats on going sober, your story is similar to mine in that under a year ago I was hospitalised with jaundice and ascites and deemed to likely have decompensated cirrhosis, but no-one would diagnose me really despite me pushing to get a diagnosis.

A month back I had my most recent firbroscan because my good doctor said he didn’t think I had cirrhosis, so we decided let’s try again with a,fibro scan which went down from the first one I had which was 22.2kpa down to 9, also reducing my liver cap score from a high of over 340 to 144. That’s 10 months worth of sobriety, healthy eating and regular exercise.

Now they state my liver is in line with moderate fibrosis, I’m awaiting the results of my US which I had last week. The person doing it did say my portal vein is fine and there is zero signs of ascites. But I still believe I’ve damaged my liver where it won’t ever return back to being 100%. I’ll take that though given where I was at and where I’d be now if I carried on drinking, dead.

Keep doing what you’re doing, you’ve done amazing.

[Confused-one in reply to Grassroots112]

Straight back atcha! Congratulations on your hard work while also recognising our good fortune.

Yes, there's moderate fibrosis but as my consultant says, as long as one keeps to this good parth there is no reason for it to get worse. We have used up pretty much all the cat's spare lives though so I just try and remain very grateful and consider this a first and only public warning...

[Grassroots112 in reply to Confused-one]

Thanks and yeah that’s me. I’ve had my reality check now and I don’t ever want to be in the state I put myself in health wise ever again. It’s funny you mentioned covid btw, I’ve tested positive for it 3 times and I’ve never been the same since I got it the first time, and especially after my jabs, my health seemed to deteriorate rapidly from getting it to my second jab.

I’m not a conspiracy theorist and I selfishly only got jabbed to go on holiday because I’m the type who doesn’t even like taking a paracetamol for a headache, but I do accept that my drinking was the biggest causing factor for my recent health issues.

I do wonder if that was accelerated by Covid, however. I know my drinking went from a lot but manageable to heavy heavy drinking during lockdown etc. But again, covid wiped me out first time and since all of that I can no longer do things physically as well or at all that I could prior to it.

But I can’t complain really because mentally I’ve never felt better in my life and if the price to pay for a decade of heavy drinking which become drinking 3 bottles of whiskey a week solid for 2 years is some aches and pains, muscle cramps, some nerve damage, being thinner than I’d like and with a fibrotic liver, then I’ll take that because I was only ever heading one way and I believe m doctors when they said had I not went to A&E when I did and just carried on drinking, I wouldn’t have lasted another month.

Sadly alcoholism runs in my family and some of us in life seem predisposed to some kind of affliction to one addiction or another. The commercial reality of the modern world certainly doesn’t make it easy for those of us like that with 24-7 access to booze, cheap supermarket booze, constant adverts about booze, the whole social calander year built around booze, footy tournaments, birthdays, Xmas etc. Then the whole fast food, junk food lifestyle.

But hey, it’s me with the problem and it’s my responsibility to moderate my own behaviour and not moderate others or the world around me.

[Confused2024 in reply to Grassroots112]

You guys…I have had the same thought about this and did also have COVID…also in November I took the booster and went the next day for my bloodwork which I was told was fine and everyone of my liver enzymes went up…nothing too crazy but it certainly impacted them

[Katt12340]

Yes. Some excellent answers here already, but just to reassure you, I've had nodular contour, irregular contour, semi complex nodules, and the nodules resolved themselves. Your specialist will let you know if something is amiss.

Have a lovely day ☺️ xx

[Confused2024 in reply to Katt12340]

Thanks Katt - what is your diagnosis? I am hoping so much I can reverse this and heal my liver at least out of the line of fire for cirrhosis...I did the HCC screening in August and it rated me as a 1 (crossing fingers) which I understand means no regenerative cirrhotic nodules are there so that is most definitely a positive!!!

[Confused2024 in reply to Confused2024]

Also - here was latest bloodwork...all has been in range but the last month my ALT spiked which I know is not a good thing so I am being super super super diligent to not anger my liver...I was not happy to see that! My other liver enzymes though all came down - only the ALT increased...I go on the 31st to test it again and I believe it will be ok again (I had done a very strenuous workout for 2.5 hours the day before the test if that matters):

[Greengal314 in reply to Confused2024]

Did you get an AST ?

[Confused2024 in reply to Greengal314]

she has not given me AST/INR/Creatinine since I first went in the summer

[Confused2024 in reply to Greengal314]

have you ever had just ALT go up?

[Greengal314 in reply to Confused2024]

No, I haven’t.

[Confused2024 in reply to Greengal314]

It is strange because everything else came down and my platelets took a lift...I am going to not stress but I have been super stressed and not so great at drinking water so I will step up my game!! I know it will be ok the Dr was not worried...

[Greengal314]

My ALT was never high. Initially, my AST was a lot higher than ALT - indicating from alcohol. When I stopped drinking my AST dropped to normal range pretty quickly.

My AST / ALT ratio keeps getting closer to 1. I’d look at that once you get your AST. The ratio (and platelets) are part of the FIB4 calculation.

Did they prescribe any medicine? That can affect it - statins. Statins can initially raise the enzymes, in particular ALT.

[Confused2024 in reply to Greengal314]

no new medicine...I started a new brand of multi vitamin and added B12?

[Confused2024]

I know, I think it is really strange that she has not checked the AST/INR and Creatinine since the summer - especially given that I am on diuretics. I need an up to date AST for sure - the FIB 4 I am not too worried because the Elastology (mine was ultrasound but over there sounds like UK does mostly Fibroscan) my result was 9.0 kPa which is Fibrosis 2 as you interpret that but the fact that I had nodular contour (wasnt on the last ultrasound - crossing fingers/toes/boobs and anything else I can it doesn't show up next time!!) and ascites she is saying early cirrhosis. All I know is I want to keep seeing improvements whatever they label it and am working my hardest to heal my liver to the very best I can. It flipped me out to see the alt raise but the positive is the other numbers improved so I will just take it as a blip - I was under a HUGE amount of stress so perhaps that increased it too??

[Greengal314 in reply to Confused2024]

I recommend not getting too caught up in details….this is directed to both you and myself. 😂

You’ll be fine. Your numbers look pretty good. 😊 it takes time for things to heal. Give yourself some credit for your hard work and success.

[Confused2024 in reply to Greengal314]

I appreciate that so much right now - thank you!!!!! I do pretty positive thinking most days but today is knocking at me - thank you