Discrepancies Between Imaging Reports and Physician Assessments in Gastroenterology

There is a discrepancy between the imaging examination results and the radiology report compared to the physician's report?

Hello, doctor.
I have been experiencing prolonged stomach pain, pain in my left rib area, and persistent abdominal pain.
Whenever the pain in my left rib flares up, I break out in cold sweats and am unable to stand.
I also suffer from chronic gastroesophageal reflux disease (GERD) and have taken numerous acid-reducing medications, but none have provided relief.
Doctors have told me they have prescribed the strongest medications available, yet I still have not improved (this has been confirmed by more than one doctor).
Initially, I also had severe constipation, for which I took various medications without success (though it has improved somewhat now).
Later, I suspected I might have an abdominal aortic aneurysm and underwent an MRI.
Since I accessed the report early and the imaging center's report was not yet available, a cardiologist reviewed my images and informed me that my liver appeared to have issues, possibly indicating a small tumor, although it might be minor.
He advised me to see a gastroenterologist.

When I visited the gastroenterologist, the imaging center's report was available, but the doctor merely read the report to me without reviewing the images.
He stated that there were no issues, but my condition has not improved.
I researched online and found that if a doctor is not skilled in interpreting images, it could lead to misdiagnosis, which worries me.
Many doctors seem to adopt a dismissive attitude, assuming that I, being young, should not have serious problems.
Recently, I suddenly felt extremely fatigued, which alarmed my family.
Sometimes, when I stay up late, the area around my mouth turns yellow, and the soles of my feet have been persistently yellow.
My mother is concerned that there may be issues with my liver, gallbladder, or pancreas.

Previously, blood tests indicated that I do not have antibodies for hepatitis B, so I received the vaccine but did not follow up to check for antibodies.
Recently, I have been feeling chest tightness and discomfort.
After seeing an ENT specialist, I was informed that the discomfort was due to stomach acid being trapped in my chest, causing breathing difficulties and the sensation of food being stuck.
I have a history of hemorrhagic gastritis, which the doctor said had resolved, but now the pain in my rib area is frequent and intense, making it difficult for me to stand.
I also often experience bloating after eating, and sometimes I burp excessively.
I certainly hope that nothing serious is wrong, but the issues persist without resolution, and my condition seems to be worsening.

Rong, 20~29 year old female. Ask Date: 2017/08/11

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, please discuss with your physician but do not become overly anxious.
Trust the physician's judgment and continue to follow up.
Maintain a regular routine and you may try local heat application.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2017/08/11

More Info

It sounds like you are experiencing a complex array of gastrointestinal symptoms that have been persistent and troubling. Your concerns about discrepancies between imaging reports and physician assessments are valid, especially when you feel that your symptoms are not improving despite medical interventions. Let's break down your situation and address your concerns.

Understanding Your Symptoms
1. Chronic Abdominal Pain: The pain you describe, particularly in the left rib area, could be related to several underlying issues, including gastrointestinal disorders, musculoskeletal problems, or even referred pain from other organs. The fact that this pain is severe enough to cause sweating and immobility is concerning and warrants further investigation.

2. Gastroesophageal Reflux Disease (GERD): Your history of GERD and the ineffectiveness of proton pump inhibitors (PPIs) can be frustrating. While PPIs are typically effective for reducing stomach acid and alleviating GERD symptoms, some patients may not respond adequately. This could be due to various factors, including the presence of esophageal motility disorders or other underlying conditions.

3. Bowel Issues: The history of severe constipation followed by improvement is a positive sign, but it’s essential to monitor your bowel habits closely. Changes in bowel patterns can indicate underlying gastrointestinal issues.

4. Concerns About Liver Health: The mention of potential liver issues, including the possibility of a small tumor, is understandably alarming. Imaging studies like MRI can sometimes reveal abnormalities that require further evaluation through additional imaging or biopsy.

5. Fatigue and Other Symptoms: The fatigue and yellowing of your skin and mouth can be indicative of liver dysfunction or other systemic issues. It’s crucial to follow up on these symptoms, especially if they persist.

Discrepancies Between Imaging Reports and Physician Assessments
Your experience with different physicians interpreting your imaging results differently highlights a common issue in healthcare. Here are some points to consider:
- Variability in Interpretation: Different specialists may have varying levels of expertise in interpreting imaging studies. A radiologist typically reviews the images and provides a report, but the treating physician may not always have the same level of training in reading those images. This can lead to discrepancies in understanding the significance of findings.

- Clinical Correlation: Physicians often rely on clinical correlation, meaning they consider your symptoms, history, and physical examination findings alongside imaging results. If your symptoms do not align with what the imaging shows, they may downplay the findings, which can be frustrating for patients who feel unwell.

- Requesting a Second Opinion: If you feel that your concerns are not being adequately addressed, it may be beneficial to seek a second opinion from another gastroenterologist or a specialist in hepatology. They may take a more comprehensive approach to your symptoms and review your imaging studies in detail.

Recommendations for Moving Forward
1. Follow-Up Appointments: Schedule follow-up appointments with your gastroenterologist to discuss your ongoing symptoms and the need for further testing. Be explicit about your concerns and the lack of improvement.

2. Consider Additional Testing: Depending on your symptoms and the findings from your imaging studies, your doctor may recommend additional tests, such as an endoscopy, liver function tests, or even a biopsy if there are concerns about liver lesions.

3. Lifestyle Modifications: While awaiting further evaluation, consider dietary changes that may help with GERD and overall digestive health. Avoiding trigger foods, eating smaller meals, and not lying down immediately after eating can be beneficial.

4. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare provider in determining the best course of action.

5. Mental Health Support: Chronic health issues can take a toll on mental well-being. Consider speaking with a mental health professional if you find yourself feeling anxious or depressed about your health situation.

In conclusion, your symptoms and the discrepancies in medical assessments are valid concerns that deserve thorough investigation. It’s essential to advocate for your health and seek the care you need to address these ongoing issues.

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