Correlation? Pancreatic Duct - Any ideas?

wonkafloyd · December 2018

Hi again, friends. I posted earlier that I'm having a biopsy on Tuesday 12/11 based on the results of my recent mammogram re-screen and U/S results. Honestly, I was totally shocked to be called back. Below were the findings. BUT, I only found out about this because the original mobile mammogram report was deemed suspicious and posted in my patient portal (which I knew) but indicated they were waiting for comparisons to past year mammograms. The crazy part is I was in my portal looking for results of a Liver ultrasound I recently had because of pain in my upper right quadrant and elevated liver enzymes (AST/ALT) and a new case of anemia...and I found the request to go for the U/S and second screening - which is resulting in a biopsy on Tuesday, 12/11.

I was seeing a Gastroenterologist who asked me to have an Upper Endoscopic Ultrasound (EUS) because my pancreatic duct is enlarged and they couldn't get a great view - but the EUS will give a better and more thorough look. That's scheduled for 1/11/19 - unless I can get in sooner and that's based on my recent Liver U/S, elevated enzymes, and anemia.

So, now my mind is going crazy because my pain in the upper right quadrant (pancreatic duct) is so close to where the right breast mass has been seen (5:30).

Do you think these could be related?

EXAM: RIGHT BREAST ULTRASOUND

Area scanned: Right breast 5:30 N4 and right axila

FINDINGS: There is a hypoechoic oval mass with partially indistinct and partially circumscribed margins in the right breast at 5:30 N4 measuring 1.1 x 1.1 x 0.4 cm. The areas of indistinct margins appear somewhat angular. This mass corresponds to the focal asymmetry seem on prior mammogram. There are morphologically benign-appearing right axillary lymph nodes.

IMPRESSION:

1. Indeterminate mass in the right breast at 5:30 N4. Recommend ultrasound-guided biopsy.

ASSESSMENT:

ACR BI-RADS Category 4 - Suspicious.

RECOMMENDATION:

1. Biopsy Right

MelissaDallas · December 2018

Anything is possible, but there are favorable things in the description of the mass they will biopsy as to it being benig, plus your nodes look benign, which makes it even less likely they are related.

wonkafloyd · December 2018

Thanks for that great perspective. Appreciate it!

wonkafloyd · December 2018

Thanks for that great perspective. Appreciate it!

djmammo · December 2018

wonkafloyd

Do you have an abdominal cat scan report or just a RUQ ultrasound? Can you post that report? You said pancreatic duct. Did they also mention the bile ducts?

There are circumstances under which these two things could be related however it would be very odd at this point unless you have had breast cancer in the past. Have you noticed any yellowing of your skin or the whites of your eyes?

wonkafloyd · December 2018

Thanks, Djmammo. I only had an U/S of the right upper quadrant and I’m now going to have an Endoscopic U/S. Here's my report. I was originally seen due to pain/pressure/feeling crowded in my right upper quadrant.

RIGHT UPPER QUADRANT ABDOMEN ULTRASOUND

EXAM DATE AND TIME: 11/27/2018 7:59 AM
INDICATION: Left upper quadrant abdominal pain.
TECHNIQUE: Gray-scale sonography imaging performed of the right upper
quadrant with real-time image documentation.
COMPARISON: None.
FINDINGS:
LIVER: There is an increased slightly heterogeneous hepatic
parenchymal echotexture suggesting fatty infiltration. No focal solid
or cystic hepatic lesions are identified.
GALLBLADDER: There has been a prior cholecystectomy.
BILIARY: The extrahepatic biliary system is not well demonstrated. No
definite intrahepatic biliary dilatation present.
PANCREAS: Mostly obscured by overlying bowel gas artifact. The
pancreatic duct appears mildly prominent.
PERITONEUM: No free fluid present.
RIGHT KIDNEY: No shadowing calculi or hydronephrosis. No significant
parenchymal abnormality.
IMPRESSION:
1. Heterogeneous increased hepatic parenchymal echotexture consistent
with fatty infiltration.
2. Prior cholecystectomy.
3. Extrahepatic biliary ductal system is not well visualized. No
intrahepatic biliary ductal dilatation.

4. Mild pancreatic ductal dilatation of uncertain etiology.

djmammo · December 2018

wonkafloyd

Gas is to ultrasound as lead is to x-rays.

How long ago was your gall bladder removed? Was the recent pain similar to the pain you had before you had your gall bladder removed?

wonkafloyd · December 2018

Djmammi,

My gall bladder was removed in 2002. This is a different pain. With that, I literally had a crazy quick onset of nausea, vomiting, typical stomach stuff just one time but I knew it was different than any other issues. I went to DR who sent me for an US and they literally took out my GB within a few hours.

These current symptoms are pain for the last few months under/behind the right lower rib. The pain is totally tolerable but it’s more of a weird sensation like movement (similar to when I was pregnant and a baby foot lodged under my rib). There’s weird pressure and twinges and it trickles into my side. It’s the strangest sensation and feels really abnormal which is why I scheduled an appointment with a gastroenterologist.

EUS scheduled for 1/11/19 but I’m top on a cancellation list so I hope to go sooner. Need to get thru this breast biopsy on Tuesday first.

High anxiety (not clinically, more figuratively I think) for me right now! Any ideas you have I’ll take! Thanks for being part of this group.

djmammo · December 2018

wonkafloyd

The very area they need to see anatomically was obscured by gas which is exrememly common as a loop of duodenum lives in the area they need to see, as depicted in this diagram. This shows the relationship between the bile ducts and the pancreatic duct. They join as they enter the duodenum at the major duodenal papilla. The trans esophageal US should be less hampered by gas. If they cant tell from that they may do a cat scan. Since there is a GI specialist involved they may opt for and ERCP instead of a cat scan. We used to give the patient a glass of water during an ultrasound to try to move the gas out of the way.

wonkafloyd · December 2018

Thanks for the great info! I’ll keep you posted.

Correlation? Pancreatic Duct - Any ideas?

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