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Crohn's Disease Forum » Tests for IBD » Need Help With MRI: Trace Free Fluid In Pelvis; Terminal Ileum Thickening.


05-15-2013, 11:10 AM   #1
KnightRobby
 
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Need Help With MRI: Trace Free Fluid In Pelvis; Terminal Ileum Thickening.

I doctor briefly went over my MRI report with me and because I was absolutely exhausted, I of course didn't read the report that was in his hands until after the appointment. I trusted the info coming out of his mouth. He failed to mention the Trace Free Fluid in Pelvis and CHRONIC mentionings of the Mild wall thickening of the terminal ileum. However, he doesn't know if it is or isn't Crohn's.

I recently had an abdominal MRI done and this is the findings:

Gastrointestinal Tract: No bowel obstruction. No reversal of the ileal jejunal fold pattern. There is mild circumferential wall thickening of the terminal ileum, without appreciable mural stratification or adjacent inflammatory chance. This does not demonstrate hyperemia relative to the remaining bowel wall. No additional focal small bowel wall thickening or hyperemia is identified.

Impressions:
1. Mild wall thickening of the terminal ileum is favored to be chronic given the lack of adjacent inflammation and lack of mural stratification.
2. Trace nonspecific free fluid within pelvis.

Everything else was normal, including liver, spleen, kidneys, adrenal glands, pancreas, gallbladdaer, aorta, lymph nodes, etc.

However, I am in significant lower abdominal pain and I have extreme tightness all around. Even if I eat something incredible healthy, like insoluble and soluble fiber (avocados being my safe food).

I have done some research and have read that trace fluid in pelvis is more common in women. However, I have also read it is most commonly due to bursts cysts and/or lesions.

Does anyone have any thoughts about this? My doctor read me my results and completely left out the part about trace free fluid within pelvis. What are treatment options? It irritates me he didn't even mention it until I got my MRI results copied from the doctor's office today.

I am doing a capsule endoscopy...would that help with the trace fluid problem? I have heard it can lead to cancer.

And any thoughts on the terminal ileum thickening?

Thank you!

Last edited by KnightRobby; 05-15-2013 at 11:59 AM.
05-15-2013, 12:44 PM   #2
Ihurt
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Hmmm. not sure about the terminal wall thickening. But I also had the small amount of free fluid in the pelvis, this is normal from what I was told. I was told that this is a common finding during certain times of a women's cycle.

I would question the doc on the wall thickening though. I would ask what is causing that. The pill cam may or may not find anything. From what I hear it only can pick up so much since it only has the camera on one end so it would be easy to miss something. I had an MRE of the small bowel which is suppose to be the better test in terms of seeing the inside of the small bowel. Not sure how great any of these tests really are, I mean they only as good as the person reading them...

Good luck and hope you get some answers!
05-15-2013, 04:01 PM   #3
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Isn't an MRE an MRI but basically where you drink tons of liquid? I've already done that, I believe, and it was very detailed. I just don't know how familiar my doc is with Celiac/Crohn's at this point.

The MRI was of my entire abdominal region and basically all organs in that region. I just hope I don't have to do ANOTHER MRI. I've already done nearly 5 of them in my life and that doesn't count X-Rays and CT Scans.

Anyway, does anyone have an opinion on the fluid? I've read I should be started on antibiotics or steroids right now. I believe I'll request this if anything...
05-15-2013, 06:06 PM   #4
DustyKat
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Hey KnightRobby,

Both of my kids had ultrasounds that found free fluid in the abdominal cavity.

My daughter was 14 at the time and undiagnosed. She had 38ml of fluid in the pouch of douglas (female anatomy) which is located in the pelvis. I asked about it at the time and they put it down to a burst ovarian follicle. She had emergency surgery 2 weeks later and she was a mess inside. It turned out the free fluid was pus.

My son's ultrasound, in the lead up to diagnosis also showed free fluid, not in the pelvis but higher up in the abdominal cavity. He was 17 at the time and had difficulty explaining away why a young male would have it. So they really had no explanation. He was diagnosed via scope a week or so later.

I don't really know the cause of the free fluid in my son's case but in view of the way his disease progressed and the fact that Crohn's affects all layers of the bowel I have to wonder if it was fluid produced from the inflammatory process.

They both have ileal Crohn's.

Based on your results I would keep pushing for answers and would have Crohn's firmly on the radar.

An MRI and MRE are different. An MRE is a far more detailed test of the small bowel as the oral contrast used is designed to line the small bowel rather than be absorbed by it.

Dusty. xxx
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05-15-2013, 10:56 PM   #5
KnightRobby
 
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I'm sorry to hear about that Dusty. I hope they are both doing better now. Your son sounded like he had trouble getting treatment for it. Is he doing better now and was it treated? I understand from little reading that taking sodium completely out of the diet is very important and maybe using natural diuretics.

I just feel like I am getting worse and worse. And the doctors are so uneducated, I have no way of really knowing if they even know the proper path to take. I can't get him to write out any kind of medication, antibiotic or otherwise. He has to look at my pill cam results which will take up to 2 weeks...

Thanks for the response. I do really appreciate it. Good to know you are there for your kids
05-16-2013, 05:20 AM   #6
DustyKat
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Ugh! I hope you get solid answers and treatment very soon mate.

Both of my kids ended up needing the same surgery but they have had very good outcomes. They had their surgeries 7 years and 2 years ago respectively and both have been in remission since then.

Dusty.
05-16-2013, 03:54 PM   #7
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Thanks Dusty. I hope I find some answers too. Wish the weekend wasn't here or better yet doctors worked 24/7 - haha

So do you recall if the have trace amounts of pelvic fluid, moderate amounts, or high amounts? I have trace amounts. I understand that could be normal (or not) due to the natural way the pelvis moves in the body. Or from the Kidney's reaction to laxatives, which I did use Milk of Magnesium...Can't recall if it was around that time though. To be the MRI's Impressions' report though. They didn't say if it was normal or not...which is odd to me.

Anyway, it seems like everyone is not giving me straight answers these days. The internet seems to be where I find most of the help to be honest.

So glad to hear they both had good outcomes. Sounds like you've been through it!
05-16-2013, 04:22 PM   #8
DustyKat
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Always seems to be that when the shit hits the fan it is a Friday or weekend.

IIRC the amount Sarah had in the pelvis would be considered significant. I'm sure the ultrasound said 38mls but when they operated it was more like 60mls, so definitely not a trace.
Matt's didn't really state an amount aside from 'some' free fluid. I know from the tone of the report they were puzzled as to why it would be there and in the conclusion stated that if it was clinically indicated further testing should be done. As it was he went for another urgent ultrasound as they failed to pick up any other abnormalities and the GI and GP didn't believe it. The reason being, Matt is very slightly built and the GP could palpate a mass in his RLQ. The second ultrasound showed reduction in the amount of free fluid but did pick up the thickening of the terminal ileum that the GP was feeling.

Have you been scoped?

Also with thickening in the ileum double check that they are confident that the pill cam won't get stuck. If they are unsure request a dummy run first, it is a dissolvable pill.

Dusty.
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