Update on Abdominal Mass

The ultrasound was ridiculous. I have never been in this situation before. The tech did the scans, then asked me to wait on the gurney while she ran them by the radiologist. Typically I’ve been told to leave and results will be published in the portal. So this was new. Within five minutes, the tech and the radiology fellow arrive together. The fellow is clearly puzzled; she takes the wand from the tech and starts pushing on the growth herself trying to figure out what this thing is. At this point, I try to offer some context to help her: I had surgery here 11 years ago, four years later I had a spitting suture that had to be operated on, maybe this is another one? She seems to buy this explanation, but admits this is “unusual,” so says she’ll talk to the attending radiologist, and they will publish a report later.

Report is published the next day with pretty benign findings. I email my oncologist and my plastic surgeon who made the original incisions and the procedure to close up the spitting stitches:

Hello Dr Gimbel and Dr Puhalla-

On Thursday, I went for an ultrasound as directed by Dr Puhalla for a growth I found in the same spot where Dr Gimbel performed a procedure to remove a “spitting suture” in 2017 (in an incision line from abdominal flap surgery he performed in 2013). A note that this spot did show up on PET scan in 2019 (if I recall correctly, it was biopsied, which revealed nothing). The radiology fellow who read the ultrasound said she had never seen anything like this before; she had no idea what it was. I explained that I’d had spitting stitches in the past, and wondered if perhaps this was what was happening again. She said she’d have the attending radiologist review the scans.

These are his findings:

FINDINGS:
There is a subcutaneous complex fluid collection in the left lower
abdominal wall along the left aspect of the surgical incision which
measures 4.4 x 2.1 x 3.9 cm. There are a few linear internal
echogenicities which may reflect retained surgical material. There is
mild subcutaneous edema. There is no abnormal or concerning internal
vascularity to suggest a mass.

I am wondering if either of you find these concerning or have a next step to suggest. This growth is not bothering me in any way; I’m happy to leave it there forever. However, I am worried it might grow or open up in the way the prior one did. Do you see anything that might suggest that? I’m wondering which of you wants to take over at this point, or if this even requires further medical attention.

Thank you!

My plastic surgeon wrote back this morning:

Hi Bryna

Thanks for your email.

It is not unusual for there to be some fluid (seroma), scar, and even old blood (debris) at a site that underwent excision in the past.  If no symptoms it does not sound concerning to me. But if Dr Puhalla has additional questions about it, it could be imaged better w CT w IV contrast.

Hope you are doing well!

I am a bit surprised by this, tbh. Not unusual? ELEVEN years later?? Ok, I guess. I have not yet heard from the oncologist, but I sort of expect that no further evaluation will be necessary.