instruction: hello doctor I have had intermittent pain in my lower left abdomen for seven months now I had a colonoscopy as soon as the pain started in the summer but there were no abnormalities seen there might have been something as the doctor muttered there is this sort of a thing here during the colonoscopy but the doctor who did the colonoscopy would not comment it further because the diagnosis lies in the biopsy samples the case was dismissed after the biopsies came back normal however the pain has continued I think that it now mostly comes before bowel movements unlike before which was more random suggesting a colonic cause but I am not sure I also have soft stools but they could be related to a high fiber diet attached are some pet it pictures were taken five and a half months after the symptoms began the radiologist claimed that there were no modular findings seen in the colon but I can see some mildly elevated modular activity as well as a possible thickening in the lower left abdomen where the symptoms are the axial view is mirrored is the structure highlighted a part of the colon wall or a lymph node what are the black areas that surround the node should I opt for another colonoscopy a needle biopsy or just forget about this
output: hello welcome to icliniq com as I read your question I just remembered how distressed my sister becomes when she gets similar pains which enables me to realize your anxieties well however her pains have been determined to be of uterine origin please note that as a radiologist I always feel confident when I can view the full set of the scan that I am asked to review however as you and the reporting radiologist are well convinced about the rest of the imagery my opinion about the selected images that you have attached is as follows the black areas represent the gas in your bowels about the encircled area please note that pet it is based on the principle that many pathological lesions accumulated much higher amounts of fog fluorodeoxy glucose than the normal tissue because of this basic principle positive findings on pet are always vidly visible this is unlike other imaging such as it mri or ray where we often have to look for subtle findings look at the urinary bladder where the excreted fog has accumulated this is excreted fog not a lesion in the bladder if there were any pet positive lesion in your abdomen it would show up as bright as the bladder now look at the area you have encircled it has some brightness and although it looks more prominent than the surroundings its appearance still does not match what we expect a lesion to look like please also note that the main image of these types of studies is the axial image and the others are reconstructed by software also the pet image is superimposed on the it image by software such manipulations often result in the creation of image artifacts in my opinion the brightness in the encircled area and its surroundings is artefactual the mild elevations that you fell you can see are likely due to the folding of the bowel loops yes there are some lesions that are pet negative and there are the causes of lower abdominal pain lap that do not create a change in imaging studies therefore your next step should be to discuss with your gastroenterologist about these types of possibilities truly lap is caused not only by cancers seen on pet but also due to vascular inflammatory invective and other pathologies exploring which may lead to the proper diagnosis and appropriate treatment I hope this helps