Ultrasound Report Interpretation — 21-year-old Male, Left Hypochondriac Pain

Report Summary (Gazi Medical College Hospital, Dr. Bithi Ghosh, 5-May-2026)

What the Ultrasound Images Show

• Top-left: Gallbladder measurements (DT 2.43 cm, D2 3.81 cm; D3 2.78 cm, Volume ~15.51 ml) — normal
• Top-right: A large structure with a measurement of 14.19 cm — this appears to be the spleen in a different plane or the left kidney (the written report calls the spleen 106 mm, which is within normal limits ≤12 cm)
• Middle row: A structure measured ~10.67 × 4.91 cm and 10.88 × 5.21 cm — consistent with left kidney dimensions
• Bottom row: Additional abdominal views — ~10.65 cm structure, likely left kidney

Note on the 14.19 cm measurement: This measurement visible on the image warrants correlation. The written report states spleen = 106 mm (10.6 cm), which is normal. The 14.19 cm image may represent an oblique/longitudinal measurement artifact or a different scan plane. Since the radiologist's final read is "normal study," this is likely a measurement taken at a different angle or of a different structure.

Clinical Interpretation: Normal Ultrasound in a Patient with Left Hypochondriac Pain

Causes NOT Visible on Routine Ultrasound:

Recommended Next Steps

1. Serum lipase & amylase — rule out pancreatitis (tail of pancreas can be missed on US)
2. Urine routine/microscopy — rule out microhematuria (renal stone)
3. CBC — check for leukocytosis (infection), anemia
4. Upper GI endoscopy — if clinical suspicion for gastritis/PUD (especially if associated with epigastric discomfort, nausea, H. pylori risk)
5. Chest X-ray — rule out left lower lobe pneumonia, pleural effusion
6. CT abdomen (with contrast) — if pain persists or worsens; more sensitive for splenic infarct, pancreatic tail, bowel pathology
7. Clinical reassessment — palpation for splenic tenderness (Traube's space), Castell's sign

Key Point

⚠️ RED FLAG: Weight Loss + Anorexia + Left Hypochondriac Pain

Most Important Differential Diagnoses (Prioritized by Urgency)

🔴 HIGH PRIORITY — Must Rule Out First

🟡 MODERATE PRIORITY

🟢 LESS LIKELY BUT CONSIDER

• Adrenal insufficiency (Addison's disease)
• Chronic infection (visceral leishmaniasis — kala-azar, endemic in Bangladesh)
• Depression / psychogenic anorexia

Why Lymphoma Must Be the Top Priority

• Left upper quadrant pain (splenic involvement region)
• Weight loss
• Anorexia (loss of appetite)

"The classic B symptoms — significant weight loss (>10% of baseline), night sweats, and persistent fever — usually signal widespread or locally extensive disease" — Goldman-Cecil Medicine

"Primary splenic lymphoma patients typically present with nonspecific symptoms, including fever, night sweats, and weight loss, and sometimes specific symptoms, such as splenomegaly and left upper quadrant pain." — Current Surgical Therapy 14e

Urgent Investigation Plan

• PET-CT scan
• Excisional lymph node biopsy (NOT fine-needle aspiration — inadequate for lymphoma diagnosis)
• Bone marrow biopsy for staging

Clinical Bottom Line

A 22-year-old male with left hypochondriac pain + weight loss + anorexia + normal ultrasound must be urgently evaluated for lymphoma (especially Hodgkin lymphoma) and abdominal tuberculosis — both common in this age group and geography, both can present with a normal abdominal ultrasound early in the course.

Diet Plan — 22-year-old South Asian Male

Goals: Reverse Weight Loss · Stimulate Appetite · Restore Nutritional Status

🔑 Nutritional Targets

🌅 Early Morning (6:30–7:00 AM)

• 1 glass warm water with soaked almonds (6–8) + 2 walnuts
• Optional: 1 banana or 2 dates

Why: Almonds + walnuts provide healthy fats and calories; banana prevents early morning nausea

🍳 Breakfast (8:00–8:30 AM)

• 2 roti / paratha (whole wheat) + 2 eggs (boiled or scrambled) + 1 cup dal
• 1 glass full-fat milk or soy milk

• Khichuri (rice + moong dal cooked together) — easy to digest, protein + carbs
• 1 boiled egg + small bowl yogurt (doi)

Why: Eggs are the most bioavailable protein source; khichuri is gentle on the stomach and calorie-dense

🥜 Mid-Morning Snack (11:00 AM)

• 1 cup lassi (yogurt + water + pinch of salt) OR 1 cup full-fat dahi (yogurt)
• A handful of roasted chana (chickpeas) or peanuts
• 1 seasonal fruit (guava, papaya, banana)

Why: Probiotic benefit from yogurt; papaya and guava aid digestion and contain vitamin C

🍛 Lunch (1:00–1:30 PM)

• 1.5–2 cups cooked rice (white rice — easier to digest than brown for poor appetite)
• 1 cup dal (lentils — masoor/moong) — excellent plant protein
• 1 medium piece fish curry (hilsa/rohu/catfish — omega-3, lean protein)
• 1 cup mixed vegetables (pumpkin, bottle gourd, spinach)
• 1 tsp ghee on rice (calorie booster)
• Small bowl raita (yogurt + cucumber)

Why: Traditional Bengali/South Asian lunch — nutritionally complete; fish is superior to red meat for a GI-symptomatic patient

☕ Evening Snack (4:30–5:00 PM)

• 1 cup milk-based beverage (horlicks, complan, or plain full-fat milk + jaggery)
• 2 whole-wheat biscuits or a small bowl of muri (puffed rice) + peanuts
• OR: 1 boiled sweet potato

🌙 Dinner (7:30–8:00 PM)

• 1.5 cups rice or 2 chapati/roti
• Chicken curry (skinless, not deep-fried) OR dal + egg (if vegetarian day)
• 1 cup sabzi (vegetable stir-fry — spinach, ridge gourd, bitter gourd)
• Small bowl soup (chicken broth or vegetable — stimulates appetite)

🌛 Bedtime (10:00 PM)

• 1 glass warm full-fat milk + 1 tsp turmeric (haldi doodh)
• 1–2 dates

Why: Turmeric has anti-inflammatory properties; milk provides casein protein for overnight muscle repair

✅ Foods to EMPHASIZE

❌ Foods to AVOID

💊 Micronutrient Supplements to Consider

⚠️ Key Clinical Note

• Avoid very high-fiber diets if bowel inflammation is suspected
• Avoid raw/unpasteurized foods (infection risk)
• If upper GI endoscopy finds gastritis or H. pylori → follow a bland, acid-reducing diet
• If TB is confirmed → ensure adequate calories (2,500+ kcal) and protein (≥1.5 g/kg) as TB is highly catabolic
• If lymphoma is diagnosed → a dietitian referral is mandatory before/during chemotherapy

Revised Diet Plan — 22-year-old South Asian Male (No Milk)

Goals: Reverse Weight Loss · Stimulate Appetite · Restore Nutritional Status

🔑 Nutritional Targets

Calcium & protein from milk replaced by eggs, fish, dal, yogurt (dahi), paneer/chhana, and nuts

🌅 Early Morning (6:30–7:00 AM)

• 1 glass warm water
• 6–8 soaked almonds + 2 walnuts + 2 dates

🍳 Breakfast (8:00–8:30 AM)

• 2 whole wheat roti/paratha + 2 scrambled/boiled eggs + 1 cup moong dal

• Khichuri (rice + moong dal) — easy to digest, calorie-dense
• 1 boiled egg + small bowl dahi (yogurt)

• Oats cooked in water + 1 banana + 1 tsp honey + peanut butter

🥜 Mid-Morning Snack (11:00 AM)

• 1 cup dahi/lassi (yogurt-based — tolerated better than plain milk)
• A handful of roasted chana or peanuts
• 1 seasonal fruit (banana, papaya, or guava)

🍛 Lunch (1:00–1:30 PM)

• 1.5–2 cups cooked rice
• 1 cup masoor/moong dal
• 1 medium piece fish curry (hilsa, rohu, catfish)
• 1 cup mixed vegetables (spinach, pumpkin, bottle gourd)
• 1 tsp ghee on rice
• Small bowl raita (yogurt + cucumber)

☕ Evening Snack (4:30–5:00 PM)

• Peanut butter on 2 whole wheat bread slices
• OR: 1 boiled sweet potato + handful of peanuts
• OR: Muri (puffed rice) + mustard oil + peanuts + sliced onion (traditional jhalmuri)

🌙 Dinner (7:30–8:00 PM)

• 1.5 cups rice or 2 chapati/roti
• Chicken curry (skinless) OR egg curry OR dal + paneer/chhana bhaji
• 1 cup vegetable sabzi (spinach, bitter gourd, ridge gourd)
• Small bowl chicken/vegetable soup (stimulates appetite)

🌛 Bedtime (10:00 PM)

• 1 small bowl dahi (yogurt) + 1 tsp honey
• OR: 2–3 dates + small handful of cashews

✅ Key Calcium & Protein Replacements (Since No Milk)

❌ Still Avoid

• Deep-fried foods, excess spice/chili
• Carbonated drinks
• Excess tea/coffee (especially before meals — kills appetite)
• Raw uncooked salads (infection risk pending diagnosis)

💊 Supplements (Same as Before)

Revised Diet Plan — 22-year-old South Asian Male

(No Milk · No Fish)

🔑 Nutritional Targets

Primary protein sources: Eggs · Chicken · Dal · Paneer/Chhana · Yogurt · Nuts

🌅 Early Morning (6:30–7:00 AM)

• 1 glass warm water
• 6–8 soaked almonds + 2 walnuts + 2–3 dates

🍳 Breakfast (8:00–8:30 AM)

• 2 whole wheat paratha/roti + 2 boiled or scrambled eggs + 1 cup moong dal

• Khichuri (rice + moong dal cooked soft) + 1 boiled egg + small bowl dahi

• Oats cooked in water + 1 banana + 1 tsp peanut butter + 1 tsp honey

🥜 Mid-Morning Snack (11:00 AM)

• 1 cup dahi (yogurt) or lassi
• Roasted chana (chickpeas) or peanuts — small handful
• 1 fruit: banana / papaya / guava

🍛 Lunch (1:00–1:30 PM)

• 1.5–2 cups cooked rice
• 1 cup dal (masoor/moong/chana dal — rotate daily)
• Chicken curry (skinless, medium spice) — 1 medium piece
• 1 cup vegetables (spinach/pumpkin/bottle gourd/potato)
• 1 tsp ghee on rice
• Small bowl raita (yogurt + cucumber)

☕ Evening Snack (4:30–5:00 PM)

• 2 whole wheat bread slices + peanut butter + sliced banana

• Jhalmuri (puffed rice + peanuts + mustard oil + onion)

• 1 boiled sweet potato + roasted peanuts

🌙 Dinner (7:30–8:00 PM)

• 1.5 cups rice or 2 chapati/roti
• Egg curry OR chicken curry OR paneer/chhana bhaji
• 1 cup vegetable sabzi (bitter gourd, ridge gourd, spinach, cauliflower)
• Small bowl chicken broth/soup — stimulates appetite, easy on stomach
• Small bowl dahi

🌛 Bedtime (10:00 PM)

• 1 small bowl dahi + 1 tsp honey
• OR 2–3 dates + small handful cashews/peanuts

✅ Protein Sources (No Milk, No Fish)

✅ Calcium Replacements (No Milk, No Fish)

❌ Avoid

• Deep-fried foods, excess chili/spice
• Carbonated soft drinks
• Tea/coffee immediately before or after meals (reduces iron absorption, kills appetite)
• Raw uncooked salads (pending diagnosis)

💊 Supplements